Why I choose to repair and not to replace the aortic valve?

  • Athanasios Antoniou
  • Amer Harky
  • Mohamad Bashir
  • Gebrine El Khoury
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta
  • 33 Downloads

Abstract

Aortic valve replacement whether surgical or transcutaneous remains an option for the treatment of severe aortic valve disease; however, current prosthetic devices are associated with complications including, but no limited to, valve thrombosis and thromboembolic events, bleeding events associated with anticoagulation use, prosthetic valve endocarditis and structural valve deterioration. In this effect, aortic valve repair (AVr) has become an attractive alternative in circumventing these potential complications by preservation of the native aortic valve apparatus. In this article, we attempt to present the progress made for AVr over the last two decades. We also wish to highlight the critical steps for successful AVr and the outcome data that demonstrate that can be first-choice treatment in selected patients and finally to emphasize on the key steps for further future development.

Keywords

Aortic valve Aortic valve repair 

Abbreviations

AV

Aortic valve

AVr

Aortic valve repair

AI

Aortic insufficiency

COR

Class of recommendation

LOE

Level of evidence

LVEF

Left ventricular ejection fraction

LVESD

Left ventricular end systolic dimension

LVEDD

Left ventricular end diastolic dimension

AVJ

Aortoventricular junction

STJ

Sinotubular junction

MV

Mitral valve

FAA

Functional aortic annulus

CVG

Composite valve graft

TAVI

Transcatheter aortic valve implantation

SCA

Subcommissural annuloplasty

References

  1. 1.
    Price J, de Kechrone L, Glineur D, Vanoverschelde JL, Noirhomme P, El Khoury G. Risk of valve-related events after aortic valve repair. Ann Thorac Surg 2013;95:606–13.CrossRefPubMedGoogle Scholar
  2. 2.
    Pibarot P, Dumesnil JG. Prosthetic heart valves: selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–48.CrossRefPubMedGoogle Scholar
  3. 3.
    David TE, Feindel CM. An aortic valve—sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardioavasc Surg 1992;103:617–21 (discussion 622).Google Scholar
  4. 4.
    Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg. 1998;115:1080–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Boodhwani M, El Khoury G. Aortic valve repair: a glimpse into the future. Eur J Cardiothorac Surg. 2012;41(1):2–3.CrossRefPubMedGoogle Scholar
  6. 6.
    Aicher D, Langer F, Adam O, Tscholl D, Lausberg H, Schafers HJ. Cusp repair in aortic valve reconstruction: does the technique affect stability? J Thorac Cardiovasc Surg. 2007;134:1533–38 (discussion 1538–9).CrossRefPubMedGoogle Scholar
  7. 7.
    de Kerchove L, Boodhwani M, Glineur D, Poncelet A, Rubay J, Watremez C, et al. Cusp prolapse repair in trileaflet aortic valves: free margin plication and free margin resuspension techniques. Ann Thorac Surg 2009;88:455–61 (discussion 461).CrossRefPubMedGoogle Scholar
  8. 8.
    Aicher D, Fries R, Radionycheva S, Schmidt K, Langer F, Schafers HJ. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg 2009;37:127–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Boodhwani M, de Kerchove L, Glineur D, Rubay J, Vanoverschede JL, Noirhomme P, et al. Repair of regurgitant bicuspid aortic valves: a systemic approach. J Thorac Cardiovasc Surg 2010;140:276–84.CrossRefPubMedGoogle Scholar
  10. 10.
    El Khoury G, de Kerchove L. Principles of aortic valve repair. J Thorac Cardiovasc Surg. 2013;145:S26–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Arimura S, Seki M, Sasaki K, Takai H, Matsuhama M, Kunihara T, et al. A nationwide survey of aortic valve surgery in Japan: current status of valve preservation in cases with aortic regurgitation. Gen Thorac Cardiovasc Surg. 2017;65(8):429–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J. 2003;24:1231–43.CrossRefPubMedGoogle Scholar
  13. 13.
    Carpentier A. Cardiac valve surgery—the “French correction”. J Thorac Cardiovasc Surg. 1983;86:323–37.PubMedGoogle Scholar
  14. 14.
    Nashimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practise guidelines. J Am Coll Cardiol. 2017;70(2):252–89.CrossRefGoogle Scholar
  15. 15.
    Swenson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O’Gara PT, et al. Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg 2013;95:1491–505 (This Society of Thoracic Surgeons Guidelines document an up to date summary of indications for ascending aorta intervention).CrossRefGoogle Scholar
  16. 16.
    Saczkowski R, Malas T, de Kerchove L, El Khoury G, Boodhwami M. Systemic review of aortic valve presentation and repair. Ann Cardiothorac Surg. 2013;2(1):3–9.PubMedPubMedCentralGoogle Scholar
  17. 17.
    de Meester C, Pasquet A, Geber B, Vancraeynest D, Noirhomme P, El Khoury G, et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg. 2014;148:1913–20.CrossRefPubMedGoogle Scholar
  18. 18.
    Ouzounian M, Rao V, Manlhiot C, Abraham N, David C, Feindel CM, et al. Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilatation. J Am Coll Cardiol. 2016;68(17):1838–47.CrossRefPubMedGoogle Scholar
  19. 19.
    Benedetto U, Melina G, Takkenberg JJ, Roscitano A, Angeloni E, Sinatra R. Surgical management of aortic root disease in Marfan syndrome: a systematic review and meta-analysis. Heart. 2011;97(12):955–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Kunihara T. Valve-sparing aortic root surgery. CON: remodeling. Gen Thorac Cardiovasc Surg. 2018.  https://doi.org/10.1007/s11748-018-08882-5 (Epub ahead of print).PubMedGoogle Scholar
  21. 21.
    Jamieson WR, Burr L, Miyagishima R, Germann E, MacNab J, Stanford E, et al. Carpentier-Edwards supra-annular aortic porcine bioprosthesis: clinical performance over 20 years. J Thorac Cardiovasc Surg. 2005;130:994–1000.CrossRefPubMedGoogle Scholar
  22. 22.
    David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg. 2006;132(2):347–54.CrossRefPubMedGoogle Scholar
  23. 23.
    Matalanis G, Perera NK. Aortic valve sparing root surgery for Marfan syndrome. Ann Cardiothorac Surg. 2017;6(6):682–91.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Malas T, Saczkowski R, Sohmer B, Ruel M, Mesana T, de Kerchove L, et al. Is aortic valve repair reproducible? Analysis of the learning curve for aortic valve repair. Can J Cardiol. 2015;31(12):1497 (E15–22).CrossRefPubMedGoogle Scholar
  25. 25.
    le Polain de Waroux JB, Pouleur AC, Robert A, Pasquet A, Gerber BL, Noirhomme P, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography. JACC Cardiovasc Imaging. 2009;2:931–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Van Dyck M, Glineur D, de Kerchove L, El Khoury G. Complications after aortic valve repair and valve-sparing procedures. Ann Cardiothorac Surg. 2013;2(1):130–9.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Urbanski PP, Jankulovski A, Doldurov K, Zhan X, Sodan A, Zacher M, et al. Reconstructive aortic valve surgery in the elderly: techniques and outcomes. J Thorac Cardiovasc Surg. 2017;17:32896–9.  https://doi.org/10.1016/j.jtcvs.2017.11.096 (Epub ahead of print).Google Scholar
  28. 28.
    Fok M, Shaw M, Sancho E, Abello D, Bashir M. Aortic valve repair: a systematic review and meta-analysis of published literature. AORTA. 2014;2(1):10–21.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2018

Authors and Affiliations

  • Athanasios Antoniou
    • 1
  • Amer Harky
    • 1
    • 2
  • Mohamad Bashir
    • 1
  • Gebrine El Khoury
    • 3
  1. 1.Department of Cardiac Surgery, Barts Heart CentreSt Bartholomew’s HospitalLondonUK
  2. 2.School of MedicineCardiff UniversityCardiffUK
  3. 3.Department of Cardiovascular and Thoracic Surgery, St Luc’s HospitalCatholic University of LouvainBrusselsBelgium

Personalised recommendations