Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H

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Presentation transcript:

Results of matching valve and root repair to aortic valve and root pathology Lars G. Svensson, MD, PhD, Lillian H. Batizy, MS, Eugene H. Blackstone, MD, A. Marc Gillinov, MD, Michael C. Moon, MD, Richard S. D’Agostino, MD, Edward M. Nadolny, CCP, William J. Stewart, MD, Brian P. Griffin, MD, Donald F. Hammer, MD, Richard Grimm, DO, Bruce W. Lytle, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 6, Pages 1491-1498.e7 (December 2011) DOI: 10.1016/j.jtcvs.2011.04.025 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Unadjusted survival stratified by operative procedure. Each symbol represents a death, vertical bars represent asymmetric 68% confidence limits (CL) equivalent to ±1 standard error, and numbers in parentheses represent patients remaining at risk. Solid lines are independently derived parametric survival estimates enclosed within dashed 68% CLs. Patients remaining at risk appear at the bottom of the figure. For reference, the dot-dash-dot line is survival for a matched US population, and dash-dot-dot-dot line matched survival after AVR for entire group. AVR, Aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Survival according to underlying pathology. Format is as in Figure 1. Single death among patients with Marfan syndrome is represented only by an actuarial estimate at time of death (purple filled circle). AVR, Aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Unadjusted freedom from reoperation according to procedure. Format is as in Figure 1. For reference, dot-dash-dot line represents age-matched reoperation for structural valve deterioration of an aortic valve bioprosthesis. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Unadjusted freedom from reoperation after bicuspid or tricuspid valve procedure (P = .002). Format is as in Figure 1. Dash-dot-dash line represents age-matched reoperation for structural valve deterioration of an aortic valve bioprosthesis. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Unadjusted freedom from reoperation according to underlying pathology. Format is as in Figure 1. Two events among the Marfan syndrome patients are depicted by actuarial estimates only (purple filled circles). Note that in patients with Marfan syndrome, the 2 failures occurred in those undergoing remodeling, not reimplantation. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Unadjusted overall survival after operation. Note decline in survival after 7.5 years in biologic AVR patients. Each symbol represents a death, vertical bars represent asymmetric 68% confidence limits (CLs) equivalent to ±1 standard error, and numbers in parentheses represent patients remaining at risk. Solid line is an independently derived parametric survival estimate enclosed within dashed 68% CLs. For reference, dash-dot-dash line is survival for a matched US population, and dash-dot-dot-dot line matched survival after AVR for entire group. AVR, Aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Unadjusted overall hazard function (instantaneous risk) for death. Note increase in deaths after 7.5 years in biologic AVR patients. Solid line is hazard estimate enclosed within 68% CLs. For reference, dot-dash-dot line is hazard function for matched US population, and dash-dot-dot-dot line is hazard function for matched population after AVR for entire group. AVR, Aortic valve replacement. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Unadjusted 2-year survival according to aortic clamp time. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Unadjusted freedom from aortic valve reoperation. Format is as in Figure E1. Dash-dot-dash line represents age-matched reoperation for structural valve deterioration of an aortic valve bioprosthesis. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E5 Unadjusted hazard function for reoperation. Note increasing rate of reoperation after 7 years in patients with aortic valve bioprostheses. Format is as in Figure E2, except that dash-dot-dash line is for age-matched rate of structural valve deterioration of aortic valve bioprostheses. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1491-1498.e7DOI: (10.1016/j.jtcvs.2011.04.025) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions