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Erschienen in: General Thoracic and Cardiovascular Surgery 7/2023

22.11.2022 | Original Article

Long-term outcomes and prognostic factors after aortic valve surgery in patients with Takayasu arteritis

verfasst von: So Hye Nam, Jino Park, Seokchan Hong, Yong-Gil Kim, Bin Yoo, Chang-Keun Lee, Dae-Hee Kim

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 7/2023

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Abstract

Background

Aortic regurgitation (AR) is a common cardiovascular complication in patients with Takayasu arteritis (TAK), and complication after aortic valve surgery (AVS) is not rare. This study aimed to identify the long-term postoperative outcomes for significant AR in patients with TAK compared with those in patients without TAK.

Methods

We included 35 patients with TAK with moderate-to-severe AR who underwent AVS and compared their postoperative outcomes with those of 105 age- and operation period-matched patients with severe AR but without TAK. The risk factors for poor outcomes [all-cause death and major adverse cardiac and cerebrovascular events (MACCE)] in patients with TAK were analyzed using multivariate Cox regression.

Results

The 10-year overall survival rate was 70.5% in patients with TAK and 89.4% in those without TAK (p = 0.048). The MACCE and reoperation rates were significantly higher in patients with TAK (10-year freedom from MACCE, 58.2% vs. 86.4% [p < 0.001]; 10-year freedom from reoperation, 64.5% vs. 98.3% [p < 0.001]). Eighteen of the 35 patients with TAK (51.4%) had poor outcomes, and multivariate analysis revealed that significant coronary artery involvement [hazard ratio (HR), 4.178; 95% confidence interval (CI), 1.222–14.282; p = 0.023] and decreased estimated glomerular filtration rate (HR, 0.968; 95% CI 0.947–0.989; p = 0.003) were associated with poor outcomes.

Conclusion

The long-term postoperative outcomes for AR were poorer in patients with TAK than in those without TAK. The poor outcomes in patients with TAK were associated with coronary artery involvement and decreased renal function.
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Literatur
1.
Zurück zum Zitat Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med. 1994;120(11):919–29. CrossRefPubMed Kerr GS, Hallahan CW, Giordano J, Leavitt RY, Fauci AS, Rottem M, et al. Takayasu arteritis. Ann Intern Med. 1994;120(11):919–29. CrossRefPubMed
2.
Zurück zum Zitat Matsuura K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Yagihara T, et al. Surgical outcome of aortic arch repair for patients with Takayasu arteritis. Ann Thorac Surg. 2006;81(1):178–82. CrossRefPubMed Matsuura K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Yagihara T, et al. Surgical outcome of aortic arch repair for patients with Takayasu arteritis. Ann Thorac Surg. 2006;81(1):178–82. CrossRefPubMed
3.
Zurück zum Zitat Comarmond C, Biard L, Lambert M, Mekinian A, Ferfar Y, Kahn JE, et al. Long-term outcomes and prognostic factors of complications in Takayasu arteritis: a multicenter study of 318 patients. Circulation. 2017;136(12):1114–22. CrossRefPubMed Comarmond C, Biard L, Lambert M, Mekinian A, Ferfar Y, Kahn JE, et al. Long-term outcomes and prognostic factors of complications in Takayasu arteritis: a multicenter study of 318 patients. Circulation. 2017;136(12):1114–22. CrossRefPubMed
4.
Zurück zum Zitat Park SJ, Kim HJ, Park H, Hann HJ, Kim KH, Han S, et al. Incidence, prevalence, mortality and causes of death in Takayasu arteritis in Korea—a nationwide, population-based study. Int J Cardiol. 2017;235:100–4. CrossRefPubMed Park SJ, Kim HJ, Park H, Hann HJ, Kim KH, Han S, et al. Incidence, prevalence, mortality and causes of death in Takayasu arteritis in Korea—a nationwide, population-based study. Int J Cardiol. 2017;235:100–4. CrossRefPubMed
5.
Zurück zum Zitat Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity. Circulation. 2015;132(18):1701–9. CrossRefPubMed Watanabe Y, Miyata T, Tanemoto K. Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity. Circulation. 2015;132(18):1701–9. CrossRefPubMed
6.
Zurück zum Zitat Matsuura K, Ogino H, Kobayashi J, Ishibashi-Ueda H, Matsuda H, Minatoya K, et al. Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality. Circulation. 2005;112(24):3707–12. CrossRefPubMed Matsuura K, Ogino H, Kobayashi J, Ishibashi-Ueda H, Matsuda H, Minatoya K, et al. Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality. Circulation. 2005;112(24):3707–12. CrossRefPubMed
7.
Zurück zum Zitat Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. 2007;84(6):1950–3. CrossRefPubMed Adachi O, Saiki Y, Akasaka J, Oda K, Iguchi A, Tabayashi K. Surgical management of aortic regurgitation associated with takayasu arteritis and other forms of aortitis. Ann Thorac Surg. 2007;84(6):1950–3. CrossRefPubMed
8.
Zurück zum Zitat Amano J, Suzuki A, Tanaka H, Sunamori M. Surgical treatment for annuloaortic ectasia in Takayasu arteritis. Int J Cardiol. 1998;66(Suppl 1):S197-202 ( discussion S3-4). CrossRefPubMed Amano J, Suzuki A, Tanaka H, Sunamori M. Surgical treatment for annuloaortic ectasia in Takayasu arteritis. Int J Cardiol. 1998;66(Suppl 1):S197-202 ( discussion S3-4). CrossRefPubMed
9.
Zurück zum Zitat Kaku Y, Aomi S, Tomioka H, Yamazaki K. Surgery for aortic regurgitation and aortic root dilatation in Takayasu arteritis. Asian Cardiovasc Thorac Ann. 2015;23(8):901–6. CrossRefPubMed Kaku Y, Aomi S, Tomioka H, Yamazaki K. Surgery for aortic regurgitation and aortic root dilatation in Takayasu arteritis. Asian Cardiovasc Thorac Ann. 2015;23(8):901–6. CrossRefPubMed
10.
Zurück zum Zitat Ando M, Kosakai Y, Okita Y, Nakano K, Kitamura S. Surgical treatment for aortic regurgitation caused by Takayasu’s arteritis. J Card Surg. 1998;13(3):202–7. CrossRefPubMed Ando M, Kosakai Y, Okita Y, Nakano K, Kitamura S. Surgical treatment for aortic regurgitation caused by Takayasu’s arteritis. J Card Surg. 1998;13(3):202–7. CrossRefPubMed
11.
Zurück zum Zitat Miyata T, Sato O, Deguchi J, Kimura H, Namba T, Kondo K, et al. Anastomotic aneurysms after surgical treatment of Takayasu’s arteritis: a 40-year experience. J Vasc Surg. 1998;27(3):438–45. CrossRefPubMed Miyata T, Sato O, Deguchi J, Kimura H, Namba T, Kondo K, et al. Anastomotic aneurysms after surgical treatment of Takayasu’s arteritis: a 40-year experience. J Vasc Surg. 1998;27(3):438–45. CrossRefPubMed
12.
Zurück zum Zitat Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American college of rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990;33(8):1129–34. CrossRefPubMed Arend WP, Michel BA, Bloch DA, Hunder GG, Calabrese LH, Edworthy SM, et al. The American college of rheumatology 1990 criteria for the classification of Takayasu arteritis. Arthritis Rheum. 1990;33(8):1129–34. CrossRefPubMed
13.
Zurück zum Zitat Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996;54(Suppl):S155–63. CrossRefPubMed Hata A, Noda M, Moriwaki R, Numano F. Angiographic findings of Takayasu arteritis: new classification. Int J Cardiol. 1996;54(Suppl):S155–63. CrossRefPubMed
14.
Zurück zum Zitat Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30(4):303–71. CrossRefPubMed Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr. 2017;30(4):303–71. CrossRefPubMed
15.
Zurück zum Zitat Amano M, Izumi C, Imamura S, Onishi N, Sakamoto J, Tamaki Y, et al. Pre- and postoperative predictors of long-term prognosis after aortic valve replacement for severe chronic aortic regurgitation. Circ J. 2016;80(12):2460–7. CrossRefPubMed Amano M, Izumi C, Imamura S, Onishi N, Sakamoto J, Tamaki Y, et al. Pre- and postoperative predictors of long-term prognosis after aortic valve replacement for severe chronic aortic regurgitation. Circ J. 2016;80(12):2460–7. CrossRefPubMed
16.
Zurück zum Zitat Li CN, Liu YM, Qi RD, Zheng J, Zhu JM, Chang Q, et al. Repair of aortic regurgitation due to Takayasu arteritis. Heart Surg Forum. 2013;16(1):E24–6. CrossRefPubMed Li CN, Liu YM, Qi RD, Zheng J, Zhu JM, Chang Q, et al. Repair of aortic regurgitation due to Takayasu arteritis. Heart Surg Forum. 2013;16(1):E24–6. CrossRefPubMed
17.
Zurück zum Zitat Nishimura S, Toubaru T, Ootaki E, Sumiyoshi T. Follow-up study of aortic-valve replacement surgery in patients with Takayasu’s disease complicated by aortic regurgitation. Circ J. 2002;66(6):564–6. CrossRefPubMed Nishimura S, Toubaru T, Ootaki E, Sumiyoshi T. Follow-up study of aortic-valve replacement surgery in patients with Takayasu’s disease complicated by aortic regurgitation. Circ J. 2002;66(6):564–6. CrossRefPubMed
18.
Zurück zum Zitat Yuan SM. Aortic regurgitation and aortic valve operation in Takayasu arteritis: a meta-analysis. Turk J Thorac Cardiovasc Surg. 2017;25(4):673–80. CrossRef Yuan SM. Aortic regurgitation and aortic valve operation in Takayasu arteritis: a meta-analysis. Turk J Thorac Cardiovasc Surg. 2017;25(4):673–80. CrossRef
19.
Zurück zum Zitat Lee GY, Jang SY, Ko SM, Kim EK, Lee SH, Han H, et al. Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center. Int J Cardiol. 2012;159(1):14–20. CrossRefPubMed Lee GY, Jang SY, Ko SM, Kim EK, Lee SH, Han H, et al. Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: analysis of 204 Korean patients at a single center. Int J Cardiol. 2012;159(1):14–20. CrossRefPubMed
20.
Zurück zum Zitat Tezuka D, Haraguchi G, Ishihara T, Ohigashi H, Inagaki H, Suzuki J, et al. Role of FDG PET-CT in Takayasu arteritis: sensitive detection of recurrences. JACC Cardiovasc Imaging. 2012;5(4):422–9. CrossRefPubMed Tezuka D, Haraguchi G, Ishihara T, Ohigashi H, Inagaki H, Suzuki J, et al. Role of FDG PET-CT in Takayasu arteritis: sensitive detection of recurrences. JACC Cardiovasc Imaging. 2012;5(4):422–9. CrossRefPubMed
21.
Zurück zum Zitat Kang DH, Park SJ, Lee SA, Lee S, Kim DH, Kim HK, et al. Early surgery or conservative care for asymptomatic aortic stenosis. N Engl J Med. 2020;382(2):111. CrossRefPubMed Kang DH, Park SJ, Lee SA, Lee S, Kim DH, Kim HK, et al. Early surgery or conservative care for asymptomatic aortic stenosis. N Engl J Med. 2020;382(2):111. CrossRefPubMed
22.
Zurück zum Zitat Jang MS, Nam JS, Jo JY, Kang CH, Ryu SA, Lee EH, et al. The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study. BMC Anesthesiol. 2019;19(1):88. CrossRefPubMedPubMedCentral Jang MS, Nam JS, Jo JY, Kang CH, Ryu SA, Lee EH, et al. The relationship of preoperative estimated glomerular filtration rate and outcomes after cardiovascular surgery in patients with normal serum creatinine: a retrospective cohort study. BMC Anesthesiol. 2019;19(1):88. CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013;118(4):809–24. CrossRefPubMed Mooney JF, Ranasinghe I, Chow CK, Perkovic V, Barzi F, Zoungas S, et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery: a systematic review and meta-analysis. Anesthesiology. 2013;118(4):809–24. CrossRefPubMed
24.
Zurück zum Zitat Nowicki ER, Birkmeyer NJ, Weintraub RW, Leavitt BJ, Sanders JH, Dacey LJ, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in northern new England. Ann Thorac Surg. 2004;77(6):1966–77. CrossRefPubMed Nowicki ER, Birkmeyer NJ, Weintraub RW, Leavitt BJ, Sanders JH, Dacey LJ, et al. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in northern new England. Ann Thorac Surg. 2004;77(6):1966–77. CrossRefPubMed
25.
Zurück zum Zitat Tjang YS, van Hees Y, Korfer R, Grobbee DE, van der Heijden GJ. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg. 2007;32(3):469–74. CrossRefPubMed Tjang YS, van Hees Y, Korfer R, Grobbee DE, van der Heijden GJ. Predictors of mortality after aortic valve replacement. Eur J Cardiothorac Surg. 2007;32(3):469–74. CrossRefPubMed
26.
Zurück zum Zitat Amano J, Suzuki A. Coronary artery involvement in Takayasu’s arteritis. Collective review and guideline for surgical treatment. J Thorac Cardiovasc Surg. 1991;102(4):554–60. CrossRefPubMed Amano J, Suzuki A. Coronary artery involvement in Takayasu’s arteritis. Collective review and guideline for surgical treatment. J Thorac Cardiovasc Surg. 1991;102(4):554–60. CrossRefPubMed
27.
Zurück zum Zitat Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American heart association. Circulation. 2018;137(12):e67–492. CrossRefPubMed Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American heart association. Circulation. 2018;137(12):e67–492. CrossRefPubMed
28.
Zurück zum Zitat Endo M, Tomizawa Y, Nishida H, Aomi S, Nakazawa M, Tsurumi Y, et al. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg. 2003;125(3):570–7. CrossRefPubMed Endo M, Tomizawa Y, Nishida H, Aomi S, Nakazawa M, Tsurumi Y, et al. Angiographic findings and surgical treatments of coronary artery involvement in Takayasu arteritis. J Thorac Cardiovasc Surg. 2003;125(3):570–7. CrossRefPubMed
29.
Zurück zum Zitat Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. Circulation. 2008;118(25):2738–47. CrossRefPubMed Ogino H, Matsuda H, Minatoya K, Sasaki H, Tanaka H, Matsumura Y, et al. Overview of late outcome of medical and surgical treatment for Takayasu arteritis. Circulation. 2008;118(25):2738–47. CrossRefPubMed
30.
Zurück zum Zitat Ohteki H, Itoh T, Natsuaki M, Minato N, Ueno T, Suda H, et al. Aortic valve replacement for Takayasu’s arteritis. J Thorac Cardiovasc Surg. 1992;104(2):482–6. CrossRefPubMed Ohteki H, Itoh T, Natsuaki M, Minato N, Ueno T, Suda H, et al. Aortic valve replacement for Takayasu’s arteritis. J Thorac Cardiovasc Surg. 1992;104(2):482–6. CrossRefPubMed
31.
Zurück zum Zitat Rav-Acha M, Plot L, Peled N, Amital H. Coronary involvement in Takayasu’s arteritis. Autoimmun Rev. 2007;6(8):566–71. CrossRefPubMed Rav-Acha M, Plot L, Peled N, Amital H. Coronary involvement in Takayasu’s arteritis. Autoimmun Rev. 2007;6(8):566–71. CrossRefPubMed
32.
Zurück zum Zitat Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, et al. Coronary artery involvement in takayasu arteritis in 45 Chinese patients. J Rheumatol. 2013;40(4):493–7. CrossRefPubMed Sun T, Zhang H, Ma W, Yang L, Jiang X, Wu H, et al. Coronary artery involvement in takayasu arteritis in 45 Chinese patients. J Rheumatol. 2013;40(4):493–7. CrossRefPubMed
Metadaten
Titel
Long-term outcomes and prognostic factors after aortic valve surgery in patients with Takayasu arteritis
verfasst von
So Hye Nam
Jino Park
Seokchan Hong
Yong-Gil Kim
Bin Yoo
Chang-Keun Lee
Dae-Hee Kim
Publikationsdatum
22.11.2022
Verlag
Springer Nature Singapore
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 7/2023
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01893-5

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