Long-Term Durability of Valve Sparing Root Replacement in Patients with and without Connective Tissue Disease.
Academic Article
Overview
abstract
OBJECTIVE: The goal of this study was to evaluate the long-term outcomes of valve-sparing root replacement (VSRR) in patients with connective tissue disease (CTD) and compare them to patients without CTD who underwent VSRR for root aneurysm. METHODS: Of 487 patients, 380 (78%) did not have CTD and 107 (22%) had CTD; 97 (91%) with Marfan syndrome, 8 (7%) with Loeys-Dietz syndrome and 2 (2%) with Vascular Ehlers-Danlos syndrome. Operative and long-term outcomes were compared. RESULTS: The CTD group was younger (36±14 vs. 53±12, p<0.001), had more females (41% vs. 10%, p<0.001) and had less hypertension (28% vs. 78%, p<0.001) and bicuspid aortic valve (8% vs. 28%, p<0.001). Other baseline characteristics did not differ between the groups. Overall operative mortality was nill (p=1.000); the incidence of major postoperative complications was 1.2% (0.9% vs. 1.3%, p=1.000) and did not differ between groups. Residual mild aortic insufficiency (AI) was more frequent in the CTD group (9.3% vs. 1.3%, p<0.001) with no difference in moderate or greater AI. Ten-year survival was 97.3% (97.2% vs.97.4%, log-rank p=0.801). Of the 15 patients with residual AI, 1 had none, 11 remained mild, 2 had moderate and one had severe AI on follow-up. Ten-year freedom from moderate/severe AI was 89.6% (HR 1.05, 95%CI 0.8-1.37; p=0.750) and 10-year freedom from valve reoperation was 94.9% (HR 1.21, 95%CI 0.43-3.39; p=0.717). CONCLUSION: The operative outcomes as well as long-term durability of VSRR is excellent in patients with or without CTD. Valve function and durability are not affected by CTD.
