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Cliniques Universitaires Saint Luc, Brussels, Belgium Université Catholique de Louvain

Intraoperative Transesophageal Echocardiographic Predictors of Recurrent Aortic Regurgitation after Aortic Valve Repair. le Polain JB, Pouleur AC, Vancraeynest D , Pasquet A , Gerber B , Vandijck M, Noirhomme P, El Khoury G, Vanoverschelde JL.

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Cliniques Universitaires Saint Luc, Brussels, Belgium Université Catholique de Louvain

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  1. Intraoperative Transesophageal Echocardiographic Predictors of Recurrent Aortic Regurgitation after Aortic Valve Repair le Polain JB, Pouleur AC, Vancraeynest D, Pasquet A, Gerber B, Vandijck M, Noirhomme P, El Khoury G, Vanoverschelde JL Cliniques Universitaires Saint Luc, Brussels, Belgium Université Catholique de Louvain

  2. Aim of the study The present study examines the intraoperativeechocardiographicfeatures associated with "late failure" of aortic valve repair.

  3. Method: Study population • From 12/1995 to 06/2007 • 186 consecutive patients (51 women, mean age: 54-Yrs) - Aortic valve repair for significant AR - With comprehensive pre-, intra- and follow-up echocardiography 122 pts (group A, 53- Yrs) with no AR 23 pts (group B, 50- Yrs) with > grade 1 AR 41 pts (group C, 63- Yrs) with recurrent severe AR • Compared for immediate post-operative TEE measurements. • Analysis of the cause of recurrence (group B & C).

  4. Method: TEE analysis • Pre-operative and immediate postoperative TEE : • Annulus • Sinuses • ST junction • Tubular aorta 120 degree -LAX • Height of the sinuses • Coaptation length • Symmetry of the coaptation • Tips to annulus • Cusp’s belly to annulus • Eccentric Jet • Vena contracta wide

  5. Results (1): Follow-up: • Mean Follow-up : 24 months • 41 pts had recurrent severe AR • 23 needed a REDO • F-up TEE identified the cause of repair failure as • Cusp prolapse: 26 pts • Restrictive cusp motion: 9 pts • Rupture of a pericardial patch : 3 pts • Aortic dissection : 2 pts • Endocarditis : 1 pt

  6. Results (2): Pre-operative characteristics

  7. Results (3): immediate post-op TEE:

  8. Results (4): Cox univariate analysis Preoperative Type 3 AR Marfan disease Postoperative The coaptation length The degree of cusp billowing The level of coaptation (relative to the annulus) The diameter of the aortic annulus The diametersino-tubular junction The presence of a residual AR The severity of residual AR (vena contracta width) Were found to correlates with AR failure

  9. Results (4): Cox multivariate analysis Independent predictors of late AR recurrence

  10. TEE decision chart

  11. Tips > annulus No Residual AR Tips > annulusResidual AR CL > 4mm Tips > annulus Residual AR CL < 4mm Tips < annulus 4-years Survival free from redo according to TEE Log rank p < 0.001

  12. Example pre and immediate post operative TEE of patient with late failure Pre-op TEE: Post-op TEE:

  13. Conclusion: Our results demonstrate that intraoperative TEE can be used to identify pts undergoing AR repair who are at increased risk for late repair failure

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