Background
The main treatment for a ruptured sinus of Valsalva aneurysm (SVA) is surgical repair.
Postoperative progression of aortic regurgitation (AR) following SVA repair increases
the risk of reoperation, which decreases the long-term survival. Thus, identifying
the risk factors for postoperative AR progression is of great significance.
Methods
Adult patients who were diagnosed with ruptured SVA and underwent surgical repair
at the current centre were reviewed. Necessary data in the institutional database
were extracted. The perioperative and follow-up assessments of the aortic valve by
transthoracic echocardiography were also obtained. The aortic regurgitation progression
was grouped into three categories: newly developing, recurrence, and worsening. Sixteen
(16) variables were screened to identify potential risk factors by univariate logistic
regression analysis or Chi-squared test. Variables with p-values <0.1 were further
analysed by multivariate logistic regression models to find independent risk factors.
Results
A total of 198 consecutive patients from June 2006 to January 2018 were included.
The overall incidence of postoperative AR progression was 19.2% (38 of 198). After
the univariate analysis, SVA originating from the right coronary sinus, coexisting
with ventricular septal defect, larger diameter of aortic annulus, and larger cardiothoracic
ratio were screened as potential risk factors. Multivariate analysis indicated that
coexisting with a ventricular septal defect (VSD) (OR, 2.82; 95% CI, 1.217–6.532;
p=0.016) and larger cardiothoracic ratio (OR, 1.061; 95% CI, 1.001–1.124; p=0.047)
were independent risk factors for postoperative AR progression.
Conclusions
To prevent postoperative AR progression after surgical repair, more careful inspection
and appropriate surgical techniques are necessary for patients coexisting with VSD
or with a larger cardiothoracic ratio.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgical repair of sinus of Valsalva aneurysm in Asian patients.Ann Thorac Surg. 2007; 84: 156-160
- Ruptured sinus of Valsalva aneurysm: transaortic repair may cause sinus of Valsalva distortion and aortic regurgitation.J Thorac Cardiovasc Surg. 2008; 135: 1153-1158
- Long-term outcome of surgical repair of ruptured sinus of Valsalva aneurysm.Circulation. 1994; 90: I20-I29
- Surgical repair of a ruptured congenital sinus of Valsalva aneurysm: 10-year experience with 286 cases.Eur J Cardiothorac Surg. 2019; 55: 1211-1218
- Recommendations for noninvasive evaluation of native valvular regurgitation.J Am Soc Echocardiog. 2017; 30: 303-371
- Sinus of Valsalva aneurysms: stabilizing the repair destabilizing the aortic valve?.J Thorac Cardiovasc Surg. 2016; 152: 1444-1445
- Repair of ruptured sinus of Valsalva aneurysm: determinants of long-term survival.Ann Thorac Surg. 1998; 66: 1604-1610
- Risk factors for preoperative and postoperative progression of aortic regurgitation in congenital ruptured sinus of Valsalva aneurysm.Ann Thorac Surg. 2011; 91: 542-548
- Progression of aortic regurgitation in Asian patients with congenital sinus of Valsalva aneurysm.Heart Surg Forum. 2013; 16: E219-E224
- Ruptured sinus of Valsalva aneurysm: early recurrence and fate of the aortic valve.Ann Thorac Surg. 2000; 70 (1470–1): 1466-1470
- Long-term results of aortic valve regurgitation after repair of ruptured sinus of Valsalva aneurysm.Ann Thorac Surg. 2002; 73: 1466-1471
- Extraction of the two-dimensional cardiothoracic ratio from digital PA chest radiographs: correlation with cardiac function and the traditional cardiothoracic ratio.J Digit Imaging. 2004; 17: 120-123
- Cardiothoracic ratio from postero-anterior chest radiographs: a simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease.Int J Cardiol. 2013; 166: 453-457
- The cardiothoracic ratio: a neglected preoperative risk-stratified method for patients with rheumatic heart disease undergoing valve replacement surgery.Eur J Cardiothorac Surg. 2019; 55: 511-517
- Cardiothoracic ratio on chest radiograph in pediatric heart disease: how does it correlate with heart volumes at magnetic resonance imaging?.Pediatr Radiol. 2015; 45: 1616-1623
- Diagnostic accuracy of cardiothoracic ratio on admission chest radiography to detect left or right ventricular systolic dysfunction: a retrospective study.J Roy Soc Med. 2015; 108: 317-324
- The long-term outcome of a surgical repair of sinus of Valsalva aneurysm.Ann Thorac Surg. 2000; 70: 727-729
- Long-term complications after surgical correction of Laubry-Pezzi syndrome.J Thorac Dis. 2016; 8: E232-E234
- Progression of aortic regurgitation after subarterial ventricular septal defect repair: optimal timing of the operation.Pediatr Cardiol. 2019; 40: 1696-1702
- Surgical repair of concomitant ventricular septal defect and aortic cusp prolapse or aortic regurgitation, also known as the Laubry-Pezzi syndrome.Ann Cardiothorac Surg. 2019; 8: 438-440
- Sinus of Valsalva aneurysms with concomitant aortic insufficiency: how should the aortic valve be managed?.Interact Cardiovasc Thorac Surg. 2018; 26: 210-215
- Surgical repair of a sinus of Valsalva aneurysm: a 22-year single-center experience.Thorac Cardiovasc Surg. 2019;
- Progression of aortic regurgitation after subpulmonic infundibular ventricular septal defect repair.Heart. 2016; 102: 1479-1484
Article info
Publication history
Published online: September 02, 2021
Accepted:
August 1,
2021
Received in revised form:
March 25,
2021
Received:
April 14,
2020
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
