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Aortic Valve Reimplantation in Patients with Connective Tissue Disorders: Are the Leaflets Durable?

Published:November 24, 2022DOI:https://doi.org/10.1016/j.jtcvs.2022.11.019
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      Structured Abstract

      Objective

      The durability of reimplanted myxomatous aortic valves in root replacements for patients with connective tissue disorders (CTD) is unclear; therefore, we sought to evaluate the long-term resilience of these repairs.

      Methods

      From 1/1980 to 1/2020, 214 patients with CTD and 645 with no-CTD underwent primary, elective aortic valve reimplantation operations at Cleveland Clinic. The CTD cohort included 164 (77%) with Marfan, 23 (11%) with Loeys-Dietz, and 7 (3.3%) with Ehlers-Danlos CTD. We accounted for differing patient characteristics between the two groups by propensity score matching to compare outcomes, yielding 96 matched pairs. Longitudinal echocardiographic measures were compared using non-linear mixed effects models.

      Results

      In the CTD cohort, there were no operative mortalities (30-day or in-hospital), 1 (0.47%) stroke, and 1 (0.47%) early in-hospital reoperation for valve dysfunction. Ten-year prevalence of no aortic regurgitation was 86%, mild 11%, and moderate 3%. Ten-year freedom from reoperation was 97%. In propensity matched cohorts, there were no significant differences in in-hospital outcomes, longitudinal aortic regurgitation and mean gradient, risk of reoperation on the aortic valve, or risk of late death.

      Conclusions

      Aortic valve reimplantation is a durable operation in patients with CTD and root aneurysms. These patients do not experience early degeneration of their reimplanted aortic valves.

      Keywords

      Glossary of abbreviations:

      CI (confidence intervals), COPD (chronic obstructive pulmonary disease), CTD (connective tissue disorder), MICE (multivariate imputation by chained equations)
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