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AORTIC VALVE REPAIR IMPROVES MID-TERM OUTCOME COMPARED TO VALVE REPLACEMENT FOR AORTIC INSUFFICIENCY: A PROPENSITY MATCHED STUDY
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Canadian Society of Cardiac Surgeons (CSCS) SURGERY HIGHLIGHTED POSTER SESSION Monday, October 26, 2015 411 AORTIC VALVE REPAIR IMPROVES MID-TERM OUTCOME COMPARED TO VALVE REPLACEMENT FOR AORTIC INSUFFICIENCY: A PROPENSITY MATCHED STUDY
Canadian Journal of Cardiology Volume 31 2015
4 years was 972% and 828% in the repair vs. replacement groups (p¼0.03). CONCLUSIONS: In a propensity matched cohort, AV repair for AI was associated with a mid-term reduction in death and serious valve related complications compared to AV replacement. AV repair should be considered, when technically feasible, as the preferred treatment of AI.
J Kapralik, M Boodhwani, V Chan, K McLean, B Sohmer, M Ruel, T Mesana Ottawa, Ontario BACKGROUND:
Aortic valve (AV) repair has emerged as a feasible and attractive alternative to AV replacement in patients with aortic insufficiency (AI) with or without aortic root pathology. However, little data exists comparing outcomes following repair versus replacement. We performed a singlecenter comparative study in patients undergoing AV repair or replacement for AI with or without aortic pathology. METHODS/RESULTS: Patients undergoing AV replacement (n¼263) or repair (n¼153) for AI between 2000 and 2014, with or without aortopathy, were included. Patients with acute aortic dissection, active endocarditis, concomitant aortic stenosis, or previous AV intervention were excluded (n¼155). Replacement patients had a higher incidence of LV dysfunction and severe AI, whereas repair patients more often had associated aortopathy. To adjust for baseline differences, nonparsimonious logistic regression models were used to generate propensity scores. A 1:1 greedy matching algorithm was used to create 70 propensity matched pairs. Peri-operative and long-term clinical and echocardiographic outcomes were assessed, focusing on survival and valve-related events, and analyzed using Kaplan-Meier techniques. Primary endpoints included late mortality, myocardial infarction (MI), stroke, and AV reoperation. Total follow-up exceeded 1100 patientyears in the entire cohort and 800 patient-years in the matched cohort. The matched replacement and repair patients were similar in age (57 14 vs. 56 15, p¼0.75), sex (Female: 18% vs. 26%, p¼0.30), incidence of LV dysfunction (27% vs. 24%, p¼0.38), severe AI (67% vs. 74% p¼0.42), presence of coronary disease (11% vs. 10%, p¼0.78) and LV End-diastolic Diameter (6.20.9 vs. 6.10.9, p¼0.63). Replacements consisted of 53% mechanical, 41% bioprosthetic, and 6% homograft valves. Repair consisted of 61% valve sparing root replacements, 70% cusp repairs with 43% bicuspid AVs. In-hospital mortality (1% vs. 4%, repair vs. replacement, p¼0.62) and perioperative outcomes were similar between groups. Four-year survival was 972% and 874% in repair vs. replacement groups (p¼0.11). A total of 5 valve-related events occurred in the repair group (1 TIA, 1 endocarditis, 3 bleeding episodes) compared to 17 in the replacement group (1 endocarditis, 2 TIAs, 2 strokes, 6 MIs, and 6 bleeding episodes). Freedom from primary endpoints (mortality, MI, strike, reoperation) at
412 OUTCOMES WITH THE SUTURELESS INTUITY VERSUS STENTED BIOLOGICAL AORTIC EDWARDS PERIMOUNT J Kapralik, M Boodhwani, V Chan, K McLean, B Sohmer, M Ruel, T Mesana Ottawa, Ontario BACKGROUND:
The aortic valve replacement (AVR) procedure is the gold standard for patients with symptomatic aortic stenosis. The development of rapid deployment aortic valves represents a significant advancement for AVR surgery. The objective of the present study is to evaluate operative results of implanting a sutureless valve the Intuity compared to the standard aortic Edwards Perimount Magna Ease. METHODS: The present case match study compares operative outcome of 90 patients who underwent AVR with the sutureless Intuity prosthesis (n¼45) or with the standard Edwards Magna Ease prostheses (n¼45) between 2012 and 2014. Patients were matched for age, gender and associated CABG procedures. RESULTS: Patients averaged 707 years of age, 80% were men and 50% were associated with CABG surgery in both groups. Euroscore was similar in both groups. Cardiopulmonary bypass time averaged 9933 versus 7924 min (p¼0.001) and cross clamp time averaged 8128 versus 6221 min (p¼0.005) respectively in Intuity and Magna Ease groups. One patient died following AVR with a standard Magna Ease prosthesis. Transprosthetic gradient averaged 145 and 134 mmHg respectively (p¼0.09). There were 4 minimal paravalvular leaks at TEE immediately after implantation of the Intuity prosthesis, 3 of these leaks were not documented at TTE one week after surgery. Three patients (3/45,7%) required the implantation of a permanent pacemaker after AVR with an Intuity prosthesis.
Canadian Society of Cardiac Surgeons (CSCS) SURGERY HIGHLIGHTED POSTER SESSION Monday, October 26, 2015 411 AORTIC VALVE REPAIR IMPROVES MID-TERM OUTCOME COMPARED TO VALVE REPLACEMENT FOR AORTIC INSUFFICIENCY: A PROPENSITY MATCHED STUDY
Canadian Journal of Cardiology Volume 31 2015
4 years was 972% and 828% in the repair vs. replacement groups (p¼0.03). CONCLUSIONS: In a propensity matched cohort, AV repair for AI was associated with a mid-term reduction in death and serious valve related complications compared to AV replacement. AV repair should be considered, when technically feasible, as the preferred treatment of AI.
J Kapralik, M Boodhwani, V Chan, K McLean, B Sohmer, M Ruel, T Mesana Ottawa, Ontario BACKGROUND:
Aortic valve (AV) repair has emerged as a feasible and attractive alternative to AV replacement in patients with aortic insufficiency (AI) with or without aortic root pathology. However, little data exists comparing outcomes following repair versus replacement. We performed a singlecenter comparative study in patients undergoing AV repair or replacement for AI with or without aortic pathology. METHODS/RESULTS: Patients undergoing AV replacement (n¼263) or repair (n¼153) for AI between 2000 and 2014, with or without aortopathy, were included. Patients with acute aortic dissection, active endocarditis, concomitant aortic stenosis, or previous AV intervention were excluded (n¼155). Replacement patients had a higher incidence of LV dysfunction and severe AI, whereas repair patients more often had associated aortopathy. To adjust for baseline differences, nonparsimonious logistic regression models were used to generate propensity scores. A 1:1 greedy matching algorithm was used to create 70 propensity matched pairs. Peri-operative and long-term clinical and echocardiographic outcomes were assessed, focusing on survival and valve-related events, and analyzed using Kaplan-Meier techniques. Primary endpoints included late mortality, myocardial infarction (MI), stroke, and AV reoperation. Total follow-up exceeded 1100 patientyears in the entire cohort and 800 patient-years in the matched cohort. The matched replacement and repair patients were similar in age (57 14 vs. 56 15, p¼0.75), sex (Female: 18% vs. 26%, p¼0.30), incidence of LV dysfunction (27% vs. 24%, p¼0.38), severe AI (67% vs. 74% p¼0.42), presence of coronary disease (11% vs. 10%, p¼0.78) and LV End-diastolic Diameter (6.20.9 vs. 6.10.9, p¼0.63). Replacements consisted of 53% mechanical, 41% bioprosthetic, and 6% homograft valves. Repair consisted of 61% valve sparing root replacements, 70% cusp repairs with 43% bicuspid AVs. In-hospital mortality (1% vs. 4%, repair vs. replacement, p¼0.62) and perioperative outcomes were similar between groups. Four-year survival was 972% and 874% in repair vs. replacement groups (p¼0.11). A total of 5 valve-related events occurred in the repair group (1 TIA, 1 endocarditis, 3 bleeding episodes) compared to 17 in the replacement group (1 endocarditis, 2 TIAs, 2 strokes, 6 MIs, and 6 bleeding episodes). Freedom from primary endpoints (mortality, MI, strike, reoperation) at
412 OUTCOMES WITH THE SUTURELESS INTUITY VERSUS STENTED BIOLOGICAL AORTIC EDWARDS PERIMOUNT J Kapralik, M Boodhwani, V Chan, K McLean, B Sohmer, M Ruel, T Mesana Ottawa, Ontario BACKGROUND:
The aortic valve replacement (AVR) procedure is the gold standard for patients with symptomatic aortic stenosis. The development of rapid deployment aortic valves represents a significant advancement for AVR surgery. The objective of the present study is to evaluate operative results of implanting a sutureless valve the Intuity compared to the standard aortic Edwards Perimount Magna Ease. METHODS: The present case match study compares operative outcome of 90 patients who underwent AVR with the sutureless Intuity prosthesis (n¼45) or with the standard Edwards Magna Ease prostheses (n¼45) between 2012 and 2014. Patients were matched for age, gender and associated CABG procedures. RESULTS: Patients averaged 707 years of age, 80% were men and 50% were associated with CABG surgery in both groups. Euroscore was similar in both groups. Cardiopulmonary bypass time averaged 9933 versus 7924 min (p¼0.001) and cross clamp time averaged 8128 versus 6221 min (p¼0.005) respectively in Intuity and Magna Ease groups. One patient died following AVR with a standard Magna Ease prosthesis. Transprosthetic gradient averaged 145 and 134 mmHg respectively (p¼0.09). There were 4 minimal paravalvular leaks at TEE immediately after implantation of the Intuity prosthesis, 3 of these leaks were not documented at TTE one week after surgery. Three patients (3/45,7%) required the implantation of a permanent pacemaker after AVR with an Intuity prosthesis.