287. The Impact of Preoperative AI Jet Eccentricity on Valve Durability Following Valve-Sparing Root Replacement
Dale S. Deas, Jr., Xiaoying Lou, Bradley G. Leshnower, Zakaria Almuwaqqat, Jose N. Binongo, LaRonica McPherson, *Edward P. Chen
Emory University, Atlanta, GA
Invited Discussant: *Thomas G. Gleason
Objective: The David V valve-sparing root replacement (VSRR) is well-established for tricuspid aortic valve (TAV) patients with aortic insufficiency (AI) and advanced root aortopathy. Jet eccentricity adds further difficulty to a durable repair. Cusp repair may be an option for patients who would have otherwise required valve replacement. However, the role of cusp repair in TAV patients with preoperative moderate-severe aortic insufficiency (AI) and an eccentric regurgitant jet is unclear. This study compares post-operative outcomes and long-term freedom from recurrent AI and valve specific re-intervention in TAV patients with >2+AI after cusp repair based on jet centricity.
Methods: A review of a single institutional database identified 309 consecutive patients undergoing VSRR from 2005-2018. Of these, 51 patients had a TAV with >2+ AI: 25 with a concentric regurgitant jet (CONCENTRIC) and 26 with an eccentric regurgitant jet (ECCENTRIC). Mean follow-up was 56 ± 44 months. Echocardiographic parameters were evaluated and compared between pre- and post-operative transthoracic echocardiogram (TTE). Kaplan-Meier analysis was used to compare long-term survival, freedom from recurrent AI, and valve specific re-intervention between groups after cusp repair.
Results: Themean age was 48 ±12 years and 84% were male. There were no differences in preoperative comorbidities or TTE parameters including ejection fraction, LV systolic and diastolic dimension, annular size, and mean transvalvular gradients. CONCENTRIC and ECCENTRIC patients underwent cusp repair at similar rates: 48.0% (n=12) vs. 57.7% (n=15), p=0.49. Rates of overall mortality, reoperation for bleeding, stroke, need for dialysis, and postoperative length-of-stay were similar in CONCENTRIC vs ECCENTRIC undergoing cusp repair. On closing TTE, 98% of patients had AI < 1+, and no patients had AI >2+. Freedom from return of AI>2+ and valve specific re-intervention was 100% in CONCENTRIC and 96% in ECCENTRIC. Long-term mortality was similar regardless of cusp repair status (Figure).
Conclusions: In selected TAV patients with preoperative AI >2+, VSRR provides a safe and durable repair regardless of the centricity of the regurgitant jet. The addition of cusp repair in these patients does not impact return of AI or rates of valve related re-intervention.