Abstract 20854: Tirone David Re-Implantation Technique: Predictive Factors of Reoperation
Objective: The aortic valve-sparing operations according to the Tirone David re-implantation technique avoid lifelong anticoagulation in case of aortic root aneurysm. The primary end point of our retrospective study was to evaluate survival without aortic valve reoperation and/or cardiac death.
Methods: From 1998 through September 2014, a total of 249 consecutive patients underwent complete aortic root replacement according to Tirone David aortic valve-sparing re-implantation technique. The median age of patients was 54 years (range from 38 to 65 years), 73% were men. A significant preoperative aortic insufficiency was present in 54% of the patients. Six patients had a previous Ross operation.
Results: Median aortic cross clamp time was 97 min. (range from 63 to 244 min.). We had three hospital deaths (1.2%) and 19 late deaths (7.7%). Median follow-up was 4.9 years (from 11 to 90 months). Overall survival was 90.7% [84,2% - 94,6% ] at 10 years. Reoperations on the aortic valve were performed in 9 patients (3.7%) for recurrent AI, we had no endocarditis. Survival without re-operation and / or cardiac death was 89.3% [82.1% - 93.7% ] at 10 years and the survival without AI ≥ 2 was 74.2% [ 65.8% ; 80.8% ] at 10 years. In multivariate analysis, predictors of reoperation and / or cardiac death were preoperative symptoms (NYHA ≥ III) (HR = 8.071 [1.286 to 50.648] p = 0.03), bicuspid aortic valve (HR = 5.109 [1.066 to 24.482] p = 0.04), AI ≥ 2 occurring during follow-up (HR = 8.834 [2.117 to 36.871] p = 0.003). Risk factors for AI ≥ 2 were: bicuspid aortic valve (HR = 2.282 [1.026 to 5.076] p = 0.04), preoperative AI ≥ 2 (HR = 2.748 [1.357 to 5.568] p = 0.005) and an aortic annulus diameter > 29 mm (HR = 2.319 [1.163 to 4.623] p = 0.00169).
Conclusion: Aortic valve-sparing operation was associated with excellent long-term results in a selected population. Bicuspid aortic valve, preoperative NYHA class III and postoperative AI were risk factors for reoperation and / or cardiac death. Significant AI, bicuspid aortic valve and a large aortic annulus diameter (>29mm) were independent risk factors for aortic valve deterioration.
Author Disclosures: A. Vincentelli: None. A. Mugnier: None. C. Pinçon: None. F. Juthier: None. N. Rousse: None. A. Coisne: None. M. Richardson: None. C. Banfi: None. A. Rauch: None. A. Prat: None.
- © 2016 by American Heart Association, Inc.