Factors Affecting Surgical Outcomes in Behcet`s Disease Patients with Severe Aortic Regurgitation

Byeongzu Ghang¹, Jung Sun Lee, MD¹, Joon Bum Kim, MD, PhD², Sung-Ho Jung, MD, PhD², Cheol Hyun Chung, MD, PhD², Jae Won Lee, MD, PhD², Jong Min Song, MD, PhD³, Duk Hyun Kang, PhD³, Dae Hee Kim, MD, PhD³; Oh Chan Kwon, MD¹, Seokchan Hong, MD, PhD¹, Yong-Gil Kim, MD, PhD¹, Chang-Keun Lee, MD, PhD¹, Bin Yoo, MD, PhD¹, Suk Jung Choo, MD, PhD²

¹Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea., ²Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea., ³Division of Cardiology, Department of Internal Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea

Purpose : The consensus for the optimal treatment of Behcet’s aortic valve or root disease remains unresolved. We aimed to investigate the impact of the surgical method, the prosthetic materials, and immunomodulation on the surgical outcomes in Behcet’s aortic valve or root disease.

Methods : We identified 23 patients with Behcet`s disease who were surgically treated for AR between January 1996 and December 2013. Significant postoperative events were defined as death, aortic valve/graft related problem(s), infective endocarditis, cerebral infarction, and/or re-operation of the aortic valve or root. Surgical procedures were classified as simple aortic valve (AVR), biologic (bARR) or mechanical aortic root replacement (cARR) depending on the technique. Allograft root replacements were included in the bARR group

Results : Aortic valve or root surgery was performed in 39 cases of confirmed Behcet’s patients, of which 4 were excluded due to inadequate medical records information for a final cohort of 35 cases. Significant events occurred in 8 (73%) of 11 simple AVR cases, 9 (75%) of 12 bARR cases (xenograft 5 and allograft 7) and 4 (33%) of 12 cARR cases. The multivariable Cox proportional hazards model indicated that the 1 month post discharge CRP level and operative age were independently associated with superior event-free survival. However, the most significant independent positive factor was the use of cARR (HR (95% CI) 0.147 (0.028 – 0.766), p = 0.023).

Conclusion : For Behcet`s aortic valve or root destruction, treating with cARR and achieving a low postoperative CRP through adjunctive immunomodulation seemed an optimal treatment strategy .

책임저자: Suk Jung Choo

Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea

발표자: Suk Jung Choo, E-mail : sjchoo@amc.seoul.kr