초록접수 현황
| 16F-162 | 구연 발표 |
Prognosis of Native Ascending Aorta following Aortic Valve Replacement
Pil Je Kang, Hee Jung Kim, Ho Jin Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee, Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : Current practice guidelines suggest concomitant replacement of ascending aorta during aortic valve replacement (AVR) when the aorta is moderately dilated; however, the evidence to support this recommendation is insufficient. The aim of this study was to evaluate the prognosis of unrepaired native ascending aorta following AVR in the setting of severe aortic stenosis (AS).
Methods : We evaluated consecutive 1055 patients (age, 65.2+10.3 yrs, 49.0% male) with severe AS who underwent AVR without concomitant repair of the ascending aorta between 2001 and 2015. Primary outcomes of interest were dissection/rupture of the ascending aorta or requirement of elective aortic repair. In addition, changes in aortic size were investigated through late echocardiographic assessments.
Results : Bicuspid aortic valve (BAV) was present in 386 patients (36.7%). Aortic sizes at baseline were <40mm in 584 (55.4%), 40-49mm in 447 (42.4%) and ≥50 in 22 (2.1%) patients. During follow-up (median 2.38 yrs, Quartile 0.86-5.06yrs), there were no cases of aortic dissection/rupture, but 4 patients received elective aortic replacement showing linearized incidence of elective aortic repair of 0.01%/ patient-year. On follow-up (n=453), the median aortic expansion rate was 0.15mm/yr (interquartile range, -0.30 to 0.95mm/yr). On multivariable linear regression model, patients’ age was positively associated with the expansion rate (beta=0.87; P=0.053) while the baseline aortic diameter was inversely associated (beta=-0.304; P<0.001: R2 of the model=0.104). The BAV, however, was not significantly associated the aortic expansion rate (P=0.74)
Conclusion : In well selected patients with moderately dilated ascending aorta, AVR alone without concomitant aortic repair showed acceptable late outcomes.
Methods : We evaluated consecutive 1055 patients (age, 65.2+10.3 yrs, 49.0% male) with severe AS who underwent AVR without concomitant repair of the ascending aorta between 2001 and 2015. Primary outcomes of interest were dissection/rupture of the ascending aorta or requirement of elective aortic repair. In addition, changes in aortic size were investigated through late echocardiographic assessments.
Results : Bicuspid aortic valve (BAV) was present in 386 patients (36.7%). Aortic sizes at baseline were <40mm in 584 (55.4%), 40-49mm in 447 (42.4%) and ≥50 in 22 (2.1%) patients. During follow-up (median 2.38 yrs, Quartile 0.86-5.06yrs), there were no cases of aortic dissection/rupture, but 4 patients received elective aortic replacement showing linearized incidence of elective aortic repair of 0.01%/ patient-year. On follow-up (n=453), the median aortic expansion rate was 0.15mm/yr (interquartile range, -0.30 to 0.95mm/yr). On multivariable linear regression model, patients’ age was positively associated with the expansion rate (beta=0.87; P=0.053) while the baseline aortic diameter was inversely associated (beta=-0.304; P<0.001: R2 of the model=0.104). The BAV, however, was not significantly associated the aortic expansion rate (P=0.74)
Conclusion : In well selected patients with moderately dilated ascending aorta, AVR alone without concomitant aortic repair showed acceptable late outcomes.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Pil Je Kang, E-mail : feel78@empas.com