Feasibility of surgical AVR with annulus dilatation in the TAVI era

Takeshi Ikuno, Yukuke Seki, Masaki Nakamura, Yutaka Sakakibara, Kazunobu Nishimura

Takamastu red cross hospital, Takamastu, Japan

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Since transcatheter aortic valve implantation (TAVI ) have been introduced, indication and choice of surgical valve implantation have changed. Mechanical valve has been the first choice in young patients so far, but it will be modified in the TAVI era. Use of the bioprosthetic valve will increase, because of expecting future TAVI treatment. Moreover, larger valve size in the first surgical operation is recommended for future valve in valve in the next TAVI. Annulus dilatation is one of the methods to solve this problem. [Objective] We examined the safety and the validity of AVR with annulus dilatation. [Methods] In our hospital, 279 patients underwent surgical AVR from January, 2009 to June, 2016, consecutively. Bentall or root reimplantation was excluded. Of these, 14 patients underwent AVR with annulus dilatation (AD group). Remaining 265 patients undersent AVR only (Control group). AD group was compared with Control groups in early and middle term. [Results] There was no significant difference in diabetes, hypertension, dyslipidemia, dialysis, arrhythmia and reoperation between both groups. No difference was observed in the light of combined surgery. There was no difference either in cardiopulmonary bypass time, aorta clamp time or operative time. All patients were followed up with an average period of 36.5±27.0 months. All cause death, cardiac events and MACCE were evaluated by Kaplan-Meier curve in both groups. Log-lank test was did not detected significantly difference between both groups. [Conclusions] Surgical AVR with annulus dilatation did not affect early or mid-term results. This procedure should be considered more aggressively in young patients., expecting future TAVI by valve in valve .