Valve-sparing root replacement and composite valve graft replacement in patients with aortic regurgitation: From the Japan Cardiovascular Surgery Database

Japan Cardiovascular Surgery Database

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: The advantage of valve-sparing root replacement (VSRR) over aortic root replacement with a composite valve graft (CVG) remains unclear. We compared these 2 procedures with regard to early outcomes with propensity score matching using the Japan Cardiovascular Surgery Database. Methods: Of 5303 patients from the Japan Cardiovascular Surgery Database who had undergone aortic root replacement in 2008 to 2017, emergent/urgent or redo cases and those with infective endocarditis or aortic stenosis were excluded (included n = 3841). Two propensity score–matched groups treated with VSRR or CVG replacement (n = 1164 each) were established. Results: Overall, VSRR was more frequently performed for younger patients with Marfan syndrome with lower operative risk and aortic regurgitation grade compared with CVG replacement. After matching, a weaker but similar trend still existed in baseline characteristics. Although more concomitant procedures were performed in the CVG group, myocardial ischemia and cardiopulmonary bypass time was significantly longer in the VSRR group (median, 193 and 245 minutes) than the CVG group (172 and 223 minutes, both P <.01). The CVG group was associated with a significantly greater incidence of postoperative stroke (2.5% vs 1.1%, P =.01) and prolonged ventilation >72 hours (7.0% vs 4.6%, P =.02). In-hospital mortality rates were significantly greater in the CVG group (1.8%) than the VSRR group (0.8%, P =.02). Conclusions: In overall Japanese institutions, VSRR was more frequently performed for patients at low risk and was associated with better morbidity and mortality rates than CVG replacement. After matching, VSRR was also associated with better morbidity and mortality rates despite longer procedure time.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

Aortic Valve Insufficiency
Japan
Databases
Transplants
Mortality
Morbidity
Marfan Syndrome
Propensity Score
Aortic Valve Stenosis
Hospital Mortality
Endocarditis
Cardiopulmonary Bypass
Myocardial Ischemia

Keywords

  • aortic regurgitation
  • composite valve graft replacement
  • database survey
  • in-hospital mortality
  • postoperative outcome
  • valve-sparing root replacement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{ba62331923704038addc2ce878f4a22e,
title = "Valve-sparing root replacement and composite valve graft replacement in patients with aortic regurgitation: From the Japan Cardiovascular Surgery Database",
abstract = "Objectives: The advantage of valve-sparing root replacement (VSRR) over aortic root replacement with a composite valve graft (CVG) remains unclear. We compared these 2 procedures with regard to early outcomes with propensity score matching using the Japan Cardiovascular Surgery Database. Methods: Of 5303 patients from the Japan Cardiovascular Surgery Database who had undergone aortic root replacement in 2008 to 2017, emergent/urgent or redo cases and those with infective endocarditis or aortic stenosis were excluded (included n = 3841). Two propensity score–matched groups treated with VSRR or CVG replacement (n = 1164 each) were established. Results: Overall, VSRR was more frequently performed for younger patients with Marfan syndrome with lower operative risk and aortic regurgitation grade compared with CVG replacement. After matching, a weaker but similar trend still existed in baseline characteristics. Although more concomitant procedures were performed in the CVG group, myocardial ischemia and cardiopulmonary bypass time was significantly longer in the VSRR group (median, 193 and 245 minutes) than the CVG group (172 and 223 minutes, both P <.01). The CVG group was associated with a significantly greater incidence of postoperative stroke (2.5{\%} vs 1.1{\%}, P =.01) and prolonged ventilation >72 hours (7.0{\%} vs 4.6{\%}, P =.02). In-hospital mortality rates were significantly greater in the CVG group (1.8{\%}) than the VSRR group (0.8{\%}, P =.02). Conclusions: In overall Japanese institutions, VSRR was more frequently performed for patients at low risk and was associated with better morbidity and mortality rates than CVG replacement. After matching, VSRR was also associated with better morbidity and mortality rates despite longer procedure time.",
keywords = "aortic regurgitation, composite valve graft replacement, database survey, in-hospital mortality, postoperative outcome, valve-sparing root replacement",
author = "{Japan Cardiovascular Surgery Database} and Takashi Kunihara and Nao Ichihara and Hiroaki Miyata and Noboru Motomura and Kenichi Sasaki and Minoru Matsuhama and Shinichi Takamoto",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.01.122",
language = "English",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

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TY - JOUR

T1 - Valve-sparing root replacement and composite valve graft replacement in patients with aortic regurgitation

T2 - From the Japan Cardiovascular Surgery Database

AU - Japan Cardiovascular Surgery Database

AU - Kunihara, Takashi

AU - Ichihara, Nao

AU - Miyata, Hiroaki

AU - Motomura, Noboru

AU - Sasaki, Kenichi

AU - Matsuhama, Minoru

AU - Takamoto, Shinichi

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: The advantage of valve-sparing root replacement (VSRR) over aortic root replacement with a composite valve graft (CVG) remains unclear. We compared these 2 procedures with regard to early outcomes with propensity score matching using the Japan Cardiovascular Surgery Database. Methods: Of 5303 patients from the Japan Cardiovascular Surgery Database who had undergone aortic root replacement in 2008 to 2017, emergent/urgent or redo cases and those with infective endocarditis or aortic stenosis were excluded (included n = 3841). Two propensity score–matched groups treated with VSRR or CVG replacement (n = 1164 each) were established. Results: Overall, VSRR was more frequently performed for younger patients with Marfan syndrome with lower operative risk and aortic regurgitation grade compared with CVG replacement. After matching, a weaker but similar trend still existed in baseline characteristics. Although more concomitant procedures were performed in the CVG group, myocardial ischemia and cardiopulmonary bypass time was significantly longer in the VSRR group (median, 193 and 245 minutes) than the CVG group (172 and 223 minutes, both P <.01). The CVG group was associated with a significantly greater incidence of postoperative stroke (2.5% vs 1.1%, P =.01) and prolonged ventilation >72 hours (7.0% vs 4.6%, P =.02). In-hospital mortality rates were significantly greater in the CVG group (1.8%) than the VSRR group (0.8%, P =.02). Conclusions: In overall Japanese institutions, VSRR was more frequently performed for patients at low risk and was associated with better morbidity and mortality rates than CVG replacement. After matching, VSRR was also associated with better morbidity and mortality rates despite longer procedure time.

AB - Objectives: The advantage of valve-sparing root replacement (VSRR) over aortic root replacement with a composite valve graft (CVG) remains unclear. We compared these 2 procedures with regard to early outcomes with propensity score matching using the Japan Cardiovascular Surgery Database. Methods: Of 5303 patients from the Japan Cardiovascular Surgery Database who had undergone aortic root replacement in 2008 to 2017, emergent/urgent or redo cases and those with infective endocarditis or aortic stenosis were excluded (included n = 3841). Two propensity score–matched groups treated with VSRR or CVG replacement (n = 1164 each) were established. Results: Overall, VSRR was more frequently performed for younger patients with Marfan syndrome with lower operative risk and aortic regurgitation grade compared with CVG replacement. After matching, a weaker but similar trend still existed in baseline characteristics. Although more concomitant procedures were performed in the CVG group, myocardial ischemia and cardiopulmonary bypass time was significantly longer in the VSRR group (median, 193 and 245 minutes) than the CVG group (172 and 223 minutes, both P <.01). The CVG group was associated with a significantly greater incidence of postoperative stroke (2.5% vs 1.1%, P =.01) and prolonged ventilation >72 hours (7.0% vs 4.6%, P =.02). In-hospital mortality rates were significantly greater in the CVG group (1.8%) than the VSRR group (0.8%, P =.02). Conclusions: In overall Japanese institutions, VSRR was more frequently performed for patients at low risk and was associated with better morbidity and mortality rates than CVG replacement. After matching, VSRR was also associated with better morbidity and mortality rates despite longer procedure time.

KW - aortic regurgitation

KW - composite valve graft replacement

KW - database survey

KW - in-hospital mortality

KW - postoperative outcome

KW - valve-sparing root replacement

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U2 - 10.1016/j.jtcvs.2019.01.122

DO - 10.1016/j.jtcvs.2019.01.122

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JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

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