Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: early outcomes of the CAVIAAR multicentric prospective cohort study

E. Lansac , O. Bouchot , E. Arnaud Crozat , R. Hacini , F. Doguet , R. Demaria (1, 2) , A. Leguerrier , J. Jouan , D. Chatel , S. Lopez , T. Folliguet , C. Acar , P. Leprince , T. Langanay , Olivier Jegaden (3) , J. P. Bessou , B. Albat , C. Latremouille , J. N. Fabiani , G. Fayad , J. P. Fleury , B. Pasquet , M. Debauchez , I. Di Centa , F. Tubach

1 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
2 EA 2992 - Caractéristiques féminines des dysfonctions des interfaces cardio-vasculaires
3 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition

OBJECTIVE: The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms. METHODS: A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided. RESULTS: The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P \textless .0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency. CONCLUSIONS: A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.

Mots clés: Aortic Valve/*abnormalities/surgery; Aortic Aneurysm/diagnosis/mortality/*surgery; *Cardiac Valve Annuloplasty/adverse effects/mortality; Heart Valve Diseases/diagnosis/mortality/*surgery; Heart Valve Prosthesis Implantation/adverse effects/*instrumentation/mortality; Disease-Free Survival; Adult; Female; Humans; Male; France; Time Factors; Aged; Logistic Models; Middle Aged; Prospective Studies; 80 and over; Risk Factors; Young Adult; Treatment Outcome; Chi-Square Distribution; Multivariate Analysis; Odds Ratio; *Heart Valve Prosthesis; *Blood Vessel Prosthesis Implantation/adverse effects/mortality; Patient Preference; Postoperative Complications/mortality/surgery; Propensity Score; Prosthesis Design; Reoperation

Domaines: Sciences du Vivant [q-bio]

E. Lansac, O. Bouchot, E. Arnaud Crozat, R. Hacini, F. Doguet, et al.. Standardized approach to valve repair using an expansible aortic ring versus mechanical Bentall: early outcomes of the CAVIAAR multicentric prospective cohort study. Journal of Thoracic and Cardiovascular Surgery, 2015, 149 (2 Suppl), pp.S37-45. ⟨10.1016/j.jtcvs.2014.07.105⟩. ⟨hal-01850674⟩