Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective
Objective: To maximize successful repair of bicuspid aortic valves by adding figure-of-8 hitch-up stitches at commissures. Methods: From 2000 to 2022, bicuspid aortic valve repair was performed on 1112 patients at Cleveland Clinic, with 367 patients receiving figure-of-8 hitch-up stitches along with...
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Elsevier
2024-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724000397 |
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| author | Fei Xiang, MD Lin Chen, BA Raphaelle Chemtob, MD Eric E. Roselli, MD Shinya Unai, MD Patrick Vargo, MD Marijan Koprivanac, MD A. Marc Gillinov, MD Eugene H. Blackstone, MD Jeevanantham Rajeswaran, PhD Austin Firth, MS Milind Y. Desai, MD, MBA Brian Griffin, MD Vidyasagar Kalahasti, MD Lars G. Svensson, MD, PhD |
| author_facet | Fei Xiang, MD Lin Chen, BA Raphaelle Chemtob, MD Eric E. Roselli, MD Shinya Unai, MD Patrick Vargo, MD Marijan Koprivanac, MD A. Marc Gillinov, MD Eugene H. Blackstone, MD Jeevanantham Rajeswaran, PhD Austin Firth, MS Milind Y. Desai, MD, MBA Brian Griffin, MD Vidyasagar Kalahasti, MD Lars G. Svensson, MD, PhD |
| author_sort | Fei Xiang, MD |
| collection | DOAJ |
| description | Objective: To maximize successful repair of bicuspid aortic valves by adding figure-of-8 hitch-up stitches at commissures. Methods: From 2000 to 2022, bicuspid aortic valve repair was performed on 1112 patients at Cleveland Clinic, with 367 patients receiving figure-of-8 hitch-up stitches along with classical techniques, including Cabrol suture, cusp plication, raphe resection, and valve-sparing root replacement. Operative outcomes, repair durability, and survival were assessed in the figure-of-8 hitch-up stitches cohort, and outcomes were compared among 195 balancing-score-matched patient pairs who underwent bicuspid aortic valve repair with and without figure-of-8 hitch-up stitches. Results: Patients who underwent bicuspid aortic valve repair with figure-of-8 stitches had an operative mortality of 0.3% (1 of 367) and in-hospital reoperation for aortic valve dysfunction of 1.1% (4 of 367). At 10 years, prevalence of severe aortic regurgitation was 8.6%, mean gradient 24 mm Hg, freedom from aortic valve reoperation 75%, and survival 98%. In matched cohorts, operative mortality was similar (0.51% vs 0%; P > .9) as were morbidities, including in-hospital reoperation due to aortic valve dysfunction (1.0% vs 1.5%; P > .9). Comparable long-term outcomes were observed at 10 years (prevalence of severe aortic regurgitation of 8.7% vs 5.0% [P = .11], mean gradient 18 vs 17 mm Hg [P = .40]; freedom from aortic valve reoperation 80% vs 81% [P = .73]; and survival 99.5% vs 94.6% [P = .18]). Conclusions: Figure-of-8 hitch-up stitch is a safe bicuspid aortic valve repair technique. It increases the likelihood of a successful repair without increasing risk of cusp tear and achieves satisfactory long-term survival and durability when added to classical repair techniques. |
| format | Article |
| id | doaj-art-5739e653696b4a2e9eb2c4769408dd97 |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-5739e653696b4a2e9eb2c4769408dd972025-08-20T03:04:53ZengElsevierJTCVS Techniques2666-25072024-04-0124274010.1016/j.xjtc.2024.01.012Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspectiveFei Xiang, MD0Lin Chen, BA1Raphaelle Chemtob, MD2Eric E. Roselli, MD3Shinya Unai, MD4Patrick Vargo, MD5Marijan Koprivanac, MD6A. Marc Gillinov, MD7Eugene H. Blackstone, MD8Jeevanantham Rajeswaran, PhD9Austin Firth, MS10Milind Y. Desai, MD, MBA11Brian Griffin, MD12Vidyasagar Kalahasti, MD13Lars G. Svensson, MD, PhD14Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing, ChinaDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Quantitative Health Sciences, Lerner Research institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OhioDepartment of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Address for reprints: Lars G. Svensson, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Desk J1-227, Cleveland, OH 44195.Objective: To maximize successful repair of bicuspid aortic valves by adding figure-of-8 hitch-up stitches at commissures. Methods: From 2000 to 2022, bicuspid aortic valve repair was performed on 1112 patients at Cleveland Clinic, with 367 patients receiving figure-of-8 hitch-up stitches along with classical techniques, including Cabrol suture, cusp plication, raphe resection, and valve-sparing root replacement. Operative outcomes, repair durability, and survival were assessed in the figure-of-8 hitch-up stitches cohort, and outcomes were compared among 195 balancing-score-matched patient pairs who underwent bicuspid aortic valve repair with and without figure-of-8 hitch-up stitches. Results: Patients who underwent bicuspid aortic valve repair with figure-of-8 stitches had an operative mortality of 0.3% (1 of 367) and in-hospital reoperation for aortic valve dysfunction of 1.1% (4 of 367). At 10 years, prevalence of severe aortic regurgitation was 8.6%, mean gradient 24 mm Hg, freedom from aortic valve reoperation 75%, and survival 98%. In matched cohorts, operative mortality was similar (0.51% vs 0%; P > .9) as were morbidities, including in-hospital reoperation due to aortic valve dysfunction (1.0% vs 1.5%; P > .9). Comparable long-term outcomes were observed at 10 years (prevalence of severe aortic regurgitation of 8.7% vs 5.0% [P = .11], mean gradient 18 vs 17 mm Hg [P = .40]; freedom from aortic valve reoperation 80% vs 81% [P = .73]; and survival 99.5% vs 94.6% [P = .18]). Conclusions: Figure-of-8 hitch-up stitch is a safe bicuspid aortic valve repair technique. It increases the likelihood of a successful repair without increasing risk of cusp tear and achieves satisfactory long-term survival and durability when added to classical repair techniques.http://www.sciencedirect.com/science/article/pii/S2666250724000397balancing scorereoperationsurvivalvalve-sparing root replacement |
| spellingShingle | Fei Xiang, MD Lin Chen, BA Raphaelle Chemtob, MD Eric E. Roselli, MD Shinya Unai, MD Patrick Vargo, MD Marijan Koprivanac, MD A. Marc Gillinov, MD Eugene H. Blackstone, MD Jeevanantham Rajeswaran, PhD Austin Firth, MS Milind Y. Desai, MD, MBA Brian Griffin, MD Vidyasagar Kalahasti, MD Lars G. Svensson, MD, PhD Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective JTCVS Techniques balancing score reoperation survival valve-sparing root replacement |
| title | Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective |
| title_full | Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective |
| title_fullStr | Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective |
| title_full_unstemmed | Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective |
| title_short | Long-term outcome of bicuspid aortic valve repair using figure-of-8 hitch-up stitchesCentral MessagePerspective |
| title_sort | long term outcome of bicuspid aortic valve repair using figure of 8 hitch up stitchescentral messageperspective |
| topic | balancing score reoperation survival valve-sparing root replacement |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724000397 |
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