Clinical Experience of Aortic Valve Surgery in Patients With Aortitis Disease
Objective: To investigate single center’s clinical experiences of aortic valve surgery for aortitis patients.
Methods: From January 2010 to December 2018, 15 patients with aortitis disease were treated in our center. Among them, there were 7 males and 8 females with an average age of 48.5 ± 13.9 (29-76) years. Six patients were diagnosed as giant cell arteritis, 2 as Takayasu arteritis (Arteritis Group, N = 8) and 7 as Behcet's disease (BD Group,
N = 7). Aortic valve surgery includes valvuloplasty, valve replacement, and root replacement (Bentall procedure).
Results: There were 15 cases with 19 operations, 8 cases in the Arteritis Group received 8 operations while 7 cases in the BD Group received 11 operations, including 4 redo operations. Preoperative patients’ aortic valve regurgitation degree, diameter of ascending aorta and left ventricular ejection fraction were similar between the two groups. The type of aortic valve surgery also was no different. Cardiopulmonary bypass time of the BD Group seemed longer than the Arteritis Group but no different, the same as clamp time. Mechanical ventilation time is longer in the BD Group. The morbidity and mortality were similar, but the BD Group had significantly higher incidence of redo operations because of postoperative paravalvular leak or valve insufficiency (Arteritis Group versus BD Group, 0% versus 57.1%, P = .026).
Conclusions: Clinical diagnosis and management of aortic valve patients with arteritis require comprehensive considerations. For aortitis patients with aortic valve surgery, special surgical techniques can be used to reduce the risk of prosthetic valve detachment.
Adachi O, Saiki Y, Akasakaa J, et al. 2007. Surgical management of aortic regurgitation associated with Takayasu arteritis and other forms of aortitis. Ann Thorac Surg 84:1950–4.
Ando M, Kosakai Y, Okita Y, et al. 1998. Surgical treatment for aortic regurgitation caused by Takayasu’s arteritis. J Card Surg 13:202–7.
Ando M, Kosakai Y, Okita Y, et al. 1999. Surgical treatment of Behçet’s disease involving aortic regurgitation. Ann Thorac Surg 68:2136–40.
Arend WP, Michel BA, Bloch DA, et al. 1990. The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 33(8):1129-34.
Azuma T, Yamazaki K, Saito S, Kurosawa H. 2009. Aortic valve replacement in Behcet's disease: surgical modification to prevent valve detachment. Eur J Cardiothorac Surg. 2009 Oct;36(4):771-2.
Chen LW, Wu XJ, Cao H, Dai XF. 2017. Valved Conduit Attached to Left Ventricular Outflow Tract for Valve Detachment in Behçet's Disease. Ann Thorac Surg. Mar;103(3):e301-e303.
Hunder GG, Bloch DA, Michel BA, et al. 1990. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 33(8):1122-8.
Jeong DS, Kim KH, Kim JS, Ahn H. 2009. Long-term experience of surgical treatment for aortic regurgitation attributable to Behçet's disease. Ann Thorac Surg. Jun;87(6):1775-82.
Jung Y, Ahn BH, Lee KS, et al. 2017. A novel solution to prosthetic valve dehiscence after aortic valve surgery in Behçet's disease. Interact Cardiovasc Thorac Surg. Mar 1;24(3):342-347.
Kobayashi S, Yano T, Matsumoto Y, et al. 2003. Clinical and epidemiologic analysis of giant cell (temporal) arteritis from a nationwide survey in 1998 in Japan: the first government-supported nationwide survey. Arthritis Rheum. 49:594–598.
Lane SE, Watts R, Scott DG. 2005. Epidemiology of systemic vasculitis. Curr Rheumatol Rep. 7:270 –275.
Reinhold-Keller E, Herlyn K, Wagner-Bastmeyer R, Gross WL. 2005. Stable incidence of primary systemic vasculitides over five years: results from the German vasculitis register. Arthritis Rheum. 53:93–99.
Salvarani C, Crowson CS, O’Fallon WM, et al. 2004. Reappraisal of the epidemiology of giant cell arteritis in Olmsted County, Minnesota, over a fifty-year period. Arthritis Rheum. 51: 264–268.
Svensson LG, Arafat A, Roselli EE, et al. 2015. Inflammatory disease of the aorta: patterns and classification of giant cell aortitis, Takayasu arteritis, and nonsyndromic aortitis. J Thorac Cardiovasc Surg. Feb;149(2 Suppl):S170-5.
Tang Y, Xu Z, Liao Z, Xu J. 2012. Supraannular aortic replacement for severe valve detachment attributable to Behçet's disease. Ann Thorac Surg. Aug;94(2):e55-7.
Saleh Z, Arayssi T. 2014. Update on the therapy of Behçet disease. Ther Adv Chronic Dis. May;5(3):112-34
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).