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Thorac Cardiovasc Surg 2020; 68(07): 567-574
DOI: 10.1055/s-0038-1675594
Original Cardiovascular

Predictors of Outcome for Aortic Valve Reimplantation Including the Surgeon—A Single-Center Experience

Sophie Tkebuchava
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Raphael Tasar
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Thomas Lehmann
2   Institute of Medical Statistics, Information Sciences and Documentation, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Gloria Faerber
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Mahmoud Diab
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Martin Breuer
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Ulrich Franke
3   Department of Cardiovascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
,
Hristo Kirov
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
,
Jan Gummert
4   Clinic for Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Bad Oeynhausen, Germany
,
Artur Lichtenberg
5   Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
,
Thorsten Wahlers
6   Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
› Author Affiliations Funding None.
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Abstract

Introduction Aortic valve reimplantation is considered technically demanding. We searched for predictors of long-term outcome including the surgeon as risk factor.

Methods We selected all aortic valve reimplantations performed in our department between December 1999 and January 2017 and obtained a complete follow-up. The main indications were combined aortic aneurysm plus aortic valve regurgitation (AR), 69% and aortic dissections (15%). In 14%, valves were bicuspid. Cusp repair was performed in 27% of patients. One-third received additional procedures (coronary artery bypass grafting, mitral, or arch surgery). We performed multivariable analyses for independent risk factors of short- and long-term outcomes, including “surgeon” as variable. Twelve different surgeons operated on 193 patients. We created three groups: surgeons A and B with 84 and 64 procedures, respectively, and surgeon C (10 surgeons for 45 patients).

Results Cardiopulmonary bypass and clamp times were 176 ± 45 and 130 ± 24 minutes, respectively. In-hospital mortality was 2%. Postoperatively, 5% had mild and 0.5% had moderate AR. Kaplan–Meier's survival estimates, freedom from reoperation, and freedom from severe AR at 12 years were 97 ± 1, 93 ± 2, and 91 ± 3%, respectively. Age and chronic obstructive pulmonary disease appeared as risk factors for perioperative complications by univariate analysis. Age, coronary artery disease, and duration of cardiopulmonary bypass, but not surgeon, presented as risk factors by multivariable analysis.

Conclusion The results suggest that if a David procedure is performed successfully, long-term durability may be excellent. They also suggest that good and durable results are possible even with limited experience of the operating surgeon.

Keywords

aortic valve reconstruction - David operation - risk factors - cardiac surgery

Note

The study was approved by the ethics committee of the Medical University of Jena, Germany (reference number 5463–03/18).




Publication History

Received: 29 June 2018

Accepted: 26 September 2018

Article published online:
28 November 2018

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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