Edward R. Nowicki, MD, MS, Gösta B. Pettersson, MD, PhD, Nicholas G

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Presentation transcript:

Aortic Allograft Valve Reoperation: Surgical Challenges and Patient Risks Edward R. Nowicki, MD, MS, Gösta B. Pettersson, MD, PhD, Nicholas G. Smedira, MD, Eric E. Roselli, MD, Eugene H. Blackstone, MD, Bruce W. Lytle, MD The Annals of Thoracic Surgery Volume 86, Issue 3, Pages 761-768.e2 (September 2008) DOI: 10.1016/j.athoracsur.2008.01.102 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Appendix Fig 1 Occurrence of first-time aortic allograft reoperations across time. Dots summarize raw data, and solid line within 68% confidence limits is a Loess fit to the raw data. The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Appendix Fig 2 Occurrence of adverse intraoperative events across the experience. Dots summarize raw data, and solid line within 68% confidence limits is a Loess fit to the raw data. The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Indications for aortic allograft valve reoperation. (A) Technical failure: pseudoaneurysm (PS) at proximal suture line circled. (B) Endocarditis: large vegetation (arrows) almost obstructing valve orifice. (C and D) Structural valve deterioration: arrows point to a perforated right coronary cusp (C) and heavy calcification of cusps (D). (L = left cusp; LCA = left main coronary artery; MV = anterior leaflet of mitral valve; NC = noncoronary cusp; R = right cusp; RCA = right coronary artery.) The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Cumulative distribution of intervals from original implant to reoperation, by indication. The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Associations among original allograft implant technique, indication for reoperation, and reoperative procedure. (A) Original allograft implant technique and reoperative procedure. (B) Indication for reoperation and reoperative procedure. (C) Indication for reoperation and original allograft implant technique. (SVD = structural valve deterioration.) The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Association of operating times and indication. (CPB = cardiopulmonary bypass time; Overall = time from incision to closure; SVD = structural valve deterioration.) The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Cumulative distribution of valve sizes, expressed as Z-value, at reoperation. (A) Human versus nonhuman valves. (B) Nonhuman prostheses, in cases of structural valve deterioration of original allograft, implanted into retained allograft root versus into native aortic root. (INC = inclusion root; RR = root replacement; SC = subcoronary.) The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Survival according to indication for reoperation. Symbols represent deaths and vertical lines represent 68% confidence limits (CL) equivalent to ± 1 SE. Solid lines are parametric estimates and dash-dot line survival of an age-sex-race–matched United States population. (IE = infectious endocarditis; SVD = structural valve deterioration; TF = technical failure). The Annals of Thoracic Surgery 2008 86, 761-768.e2DOI: (10.1016/j.athoracsur.2008.01.102) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions