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Langenbeck's Archives of Surgery

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01-02-2015 | Original Article

Aortic valve reimplantation for aortic root aneurysms: trainer and trainee differences on long-term results

Authors: Nadejda Monsefi, Patrick Primbs, Aleksandra Miskovic, Sandra Folkmann, Anton Moritz

Published in: Langenbeck's Archives of Surgery | Issue 2/2015

Abstract

Purpose

The advantages of aortic valve-preserving surgery are still hampered by a higher rate of reoperations compared to root replacement with valved conduits. This study evaluates whether valve deterioration rate is related to the method or depends on stringent adherence to technical concepts, which might be lost once trainees perform this complex surgery on their own.

Methods

From 1991 to 2011, the David procedure was performed in 209 consecutive patients. Mean age was 57 ± 14 years. The patients were operated either by the senior author or trainees under his supervision (group 1, n = 130) or by surgeons on their own after training by the senior author (group 2, n = 79). Clinical and echocardiography data were evaluated pre- and postoperatively and at follow-up (mean 6.0 ± 4 years).

Results

In-hospital mortality was 1.5 % in group 1 and 5 % in group 2 (p = 0.29), and late mortality was 12 % (n = 12 in group 1 and n = 14 in group 2, p = 0.11), three were cardiac related. Nine patients (4.3 %) had to be reoperated; three for endocarditis in group 1, six for structural valve deterioration in group 2 (p = 0.14). The 9-year freedom from reoperation or aortic valve insufficiency (AI) ≥2° was 93 % in group 1 and 78 % in group 2 (p < 0.01). As groups showed differences in preoperative variables, results were compared also in a propensity matched subgroup. Despite no difference in perioperative results, long-term valve competence remained inferior in group 2.

Conclusions

With stringent adherence to technical concepts, structural valve deterioration may virtually be considerably reduced in aortic valve reimplantation. Once performing this operation on their own, trainees—after training by the senior—achieved results as independent surgeons well comparable to published series. As long-term performance seems to depend more on judgment of the geometry achieved intraoperatively than on technical steps, a means of measurement of effective coaptation height with a caliper might facilitate evaluation of perfect repair.

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Title: Aortic valve reimplantation for aortic root aneurysms: trainer and trainee differences on long-term results
Authors: Nadejda Monsefi
Patrick Primbs
Aleksandra Miskovic
Sandra Folkmann
Anton Moritz
Publication date: 01-02-2015
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1222-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Aortic valve reimplantation for aortic root aneurysms: trainer and trainee differences on long-term results

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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