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Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus

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Abstract

Objective

At our institution, we actively perform aortic valve neocuspidization (AVNeo) for aortic valve stenosis (AS) with a small annulus. In this report, we aimed to evaluate the midterm outcome of AVNeo for AS with a small annulus.

Methods

From February 2011 to May 2017, we performed AVNeo for AS with a small annulus in 34 patients. Their mean age was 77.0 ± 9.1 years. Preoperative transthoracic echocardiography (TTE) revealed a mean peak pressure gradient average of 84.2 ± 31.1 mmHg. The effective orifice area index (EOAi) was 0.45 ± 0.14 cm2/m2. The mean annulus diameter was 18.4 ± 1.1 mm. Our procedure complies with the three cuspid suturing to the aortic annulus with glutaraldehyde-treated autologous pericardium.

Results

There were no conversion to aortic valve replacement and no concomitant annulus enlargement. There were two inhospital mortalities resulting from a noncardiac cause. Three patients underwent reoperation owing to aortic regurgitation (n = 2) and infective endocarditis (n = 1). One patient underwent a pacemaker implantation for complete atrioventricular block. The mean follow-up period was 28.0 ± 22.7 months. Postoperative TTE showed a mean peak pressure gradient average of 18.3 ± 9.4 mmHg and a calculated mean EOAi of 1.18 ± 0.35 cm2/m2. The freedom from reoperation rates were 94.1% and 90.8% at 1 year and 5 years of follow-up, respectively. The overall survival rates were 91.2% and 76.8% at 1 and 5 years of follow-up, respectively.

Conclusions

The midterm outcome of AVNeo for AS with a small annulus was excellent. The long-term outcome and reliability of this procedure must be fully clarified.

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Acknowledgements

We are indebted to Dr. Edward F. Barroga (https://orcid.org/0000-0002-8920-2607), professor and medical editor, for reviewing and editing the manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Ogikubo Hospital, 3-1-24 Imagawa, Suginami-ku, Tokyo, 167-0035, Japan

    Sho Akiyama, Yasunori Iida, Kazuma Shimura, Susumu Fujii & Shigeharu Sawa

  2. Department of Cardiovascular Surgery, Keio University, Tokyo, Japan

    Sho Akiyama, Yasunori Iida & Hideyuki Shimizu

Authors
  1. Sho Akiyama
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  2. Yasunori Iida
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  3. Kazuma Shimura
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  4. Susumu Fujii
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  5. Hideyuki Shimizu
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  6. Shigeharu Sawa
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Correspondence to Sho Akiyama.

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Akiyama, S., Iida, Y., Shimura, K. et al. Midterm outcome of aortic valve neocuspidization for aortic valve stenosis with small annulus. Gen Thorac Cardiovasc Surg 68, 762–767 (2020). https://doi.org/10.1007/s11748-020-01299-1

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  • DOI: https://doi.org/10.1007/s11748-020-01299-1

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