Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm

Xiaokang Luo; Baotong Li; Fan Ju; Chenyu Zhao; Zhenpeng Yuan; Yue Tang; Hansong Sun

doi:10.1016/j.hlc.2021.08.004

Risk Factors for Aortic Regurgitation Progression After Repair of Sinus of Valsalva Aneurysm

Heart Lung Circ. 2022 Mar;31(3):358-364. doi: 10.1016/j.hlc.2021.08.004. Epub 2021 Sep 2.

Authors

Xiaokang Luo¹, Baotong Li², Fan Ju², Chenyu Zhao³, Zhenpeng Yuan⁴, Yue Tang², Hansong Sun⁵

Affiliations

¹ Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China.
⁴ The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁵ Center of Cardiac Surgery for Adults, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: drsunhs@sina.com.

PMID: 34483051
DOI: 10.1016/j.hlc.2021.08.004

Abstract

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: Aortic regurgitation; Risk factor; Sinus of Valsalva aneurysm; Surgical repair.

MeSH terms

Adult
Aortic Aneurysm* / diagnostic imaging
Aortic Aneurysm* / epidemiology
Aortic Aneurysm* / etiology
Aortic Rupture* / surgery
Aortic Valve Insufficiency* / diagnosis
Aortic Valve Insufficiency* / epidemiology
Aortic Valve Insufficiency* / etiology
Heart Septal Defects, Ventricular* / surgery
Humans
Risk Factors
Sinus of Valsalva* / diagnostic imaging
Sinus of Valsalva* / surgery
Treatment Outcome