Boston - American Association for Thoracic Surgery

More documents

Recommendations

Info

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS36. Surgical Management of Secondary Tricuspid Valve Regurgitation:Anulus, Commissure, or Leaflet Procedure?Jose L. Navia, * Edward R. Nowicki, Eugene H. Blackstone, * Daniel E. Nento,Jeevanantham Rajeswaran, A. Marc Gillinov, * Lars G. Svensson, * Sharif Al-Ruzzeh,Bruce W. Lytle *Cleveland Clinic, Cleveland, OH, USAInvited Discussant: Farzan FilsoufiOBJECTIVE: Anuloplasty has been the main technique used to manage tricuspidvalve (TV) regurgitation (TR) accompanying left-sided heart valve disease, buttechniques at the commissure or leaflet level may also be useful. This study soughtto compare early and long-term success of procedures performed at anular, commissural,leaflet, and combined levels.METHODS: From 1990 to 2008, 2,277 patients underwent TV procedures forsecondary TR concomitantly with mitral (n = 1,527, 67%), aortic (n = 180, 8.0%), orcombined (n = 570, 25%) valve surgery. These included anulus (rigid prosthesis[n = 584, 26%], flexible prosthesis [n = 1,052, 46%], DeVega suture [129, 5.7%], andPeri-Guard [n = 185, 8.1%] anuloplasty), commissure (Kay [n = 248, 11%]),and leaflet (edge-to-edge suture [n = 79, 3.5%]) procedures. 4,745 postoperativetransthoracic echocardiograms in 1,965 patients were analyzed (median follow-up20 days) and TV reoperations identified at follow-up (median 1.2 years).RESULTS: At 3 months, prevalence of 3+/4+ TR was least for combined Kay andleaflet procedures (2.4%) and Peri-Guard anuloplasty (3.8%), and similar (8.7% to11%) for other procedures (Figure). However, by 5 years, 3+/4+ TR had increasedonly slightly to 12% for isolated rigid prothesis anuloplasty. It was progressivelygreater for all other anular procedures (flexible prosthesis [16%], DeVega [24%],and Peri-Guard [44%]), and 19% for the Kay procedure. Freedom from TV reoperationwas 98% at 5 years, similar for all procedures (P = .3).CONCLUSION: Early success of treatment for TR secondary to left-sided heartvalve disease is best sustained over time by rigid prosthesis anuloplasty alone. Theprotracted failure pattern after Peri-Guard anuloplasty suggests abandoning thisprocedure.* AATS Member164
AMERICAN ASSOCIATION FOR THORACIC SURGERY37. When Is the Ross Procedure a Good Option to Treat Aortic ValveDisease?Tirone E. David, * Anna Woo, Susan Armstrong, Manjula MagantiCardiovascular Surgery, Toronto General Hospital, Toronto, ON, CanadaInvited Discussant: Lawrence H. CohnOBJECTIVE: To identify suitable patients for the Ross procedure.METHODS: A cohort of 212 patients (mean age 34 ± 9 years, 66% men, 82% withbicuspid aortic valve disease = BAV) had the Ross procedure and was prospectivelyfollowed with clinical evaluations and echocardiography from 1 to 19 years, meanof 9.5 ± 3.7 years. In addition to longitudinal outcomes by Kaplan-Meier analysis,numerous perioperative variables were entered into a multivariable analysis toidentify predictors of failure of the procedure.RESULTS: There were one operative and four late deaths, none valve-related. Thesurvival at 15 years was 96.6 ± 1.5% and identical to the general populationmatched for age and gender. There were 18 reoperations: 11 in the pulmonaryautograft, 3 in the pulmonary homograft and 4 others. At 15 years the freedomfrom reoperation in the pulmonary autograft was 93.0 ± 2.2%, and the freedomfrom moderate or severe aortic insufficiency (AI) was 90 ± 3%. Cox regressionanalysis identified preoperative AI due to BAV as independent predictors of AI >2+ (H.R. = 3.9; 95% C.I. 2.4–5.4). The technique of implantation of the autografthad no effect on the development of late AI > 2+. There was no reoperation due toAI in patients with aortic stenosis. At 15 years the freedom from moderate to severepulmonary insufficiency and/or peak gradient >40 mmHg was 88.8 ± 2.6%, andthe event-free survival was 87.0 ± 2.8%.TUESDAYAfternoonCONCLUSION: The Ross procedure should not be performed in patients with AIdue to BAV. The long-term results in patients with aortic stenosis with or withoutBAV are excellent. This operation is an option for young adults with aortic stenosiswho choose a tissue valve.3:00 p.m. INTERMISSION – VISIT EXHIBITSExhibit Hall* AATS Member165
Page 1 and 2:
American Associationfor Thoracic Su
Page 3 and 4:
AMERICAN ASSOCIATION FOR THORACIC S
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116: AMERICAN ASSOCIATION FOR THORACIC S
Page 165: AMERICAN ASSOCIATION FOR THORACIC S
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 227 and 228:
AATS FUTURE MEETINGSMay 1-5, 2010Me
show all

Boston - American Association for Thoracic Surgery

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?