Different surgical strategies have been evolved for the surgical treatment of ruptured sinus of Valsalva aneurysm (RSVA) from simple primary closure to patching of the rupture site by a dual chamber approach. We reviewed our 25-year experience and current literature regarding the efficacy of different surgical approaches. A retrospective review identified 55 patients who underwent RSVA repair between 1985 and 2011. The mean age was 30.9 ± 12.1 years. The RSVA originated from the right coronary sinus in 43 patients (78.2%), from the non-coronary sinus in 11 (20.0%) and from the left in 1. Rupture into the right ventricle was the most common result (n = 38). Dual-chamber exposure (the involved chamber and aorta) was used in 67.3% of the patients and isolated trans-aortic approach was used in 32.7%. RSVA was repaired with either a patch (n = 43) or direct sutures (n = 12), whereas the aortic valve was replaced in eight patients among the last group. The hospital mortality rate was 3.6%. The follow-up was available in 94.3% (50 patients) of survivors ranging from 1 month to 25 years (mean 15.3 ± 4.1 years). There were five late deaths. Recurrence of the fistula was seen in two primarily repaired (two of four patients) and none of the patched-closed patients. Actual survival was 93.4 ± 3.7% at 10 years and 87.1 ± 5.6% at 15 years. Freedom from reoperations was 81.6 ± 6.1% at 15 years. Surgical treatment for RSVA carries an acceptably low operative risk and long-term freedom from death and reoperation. Surgical approach must be chosen according to the ruptured chamber and associated lesions. Patch repair of RSVA must be preferred.

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.

Hypercholesterolemia has been found to be associated with aortic valve stenosis and to resemble the inflammatory process of atherosclerosis in many studies. The aim of this study was to investigate the role of hypercholesterolemia in development of aortic valve calcification in different etiologies. The study included 988 patients with rheumatic, congenital, or degenerative aortic stenosis, who underwent aortic valve replacement at Koşuyolu Heart and Research Hospital between 1985 and 2005. Effects of hypercholesterolemia and high low-density lipoprotein level on calcific aortic stenosis or massive aortic valve calcification were analyzed for each etiologic group. Both univariate and multivariate analyses revealed that the high serum cholesterol level (>200 mg/dL) was related to massive aortic valve calcification in all patients (p = 0.003). Hypercholesterolemia was linked to calcific aortic stenosis and massive calcification in patients with degenerative etiology (p = 0.02 and p = 0.01, respectively) and it was related to massive calcification in patients with congenital bicuspid aorta (p = 0.02). Other independent risk factors for calcific aortic stenosis and massive calcification in the degenerative group were high low-density lipoprotein level (>130 mg/dL; p = 0.03 and p = 0.05, respectively) and high serum C-reactive protein level (p = 0.04 and p = 0.05, respectively). Hypercholesterolemia is related to increased risk of aortic valve calcification in patients with degenerative and congenital etiology. Preventive treatment of hypercholesterolemia could play an important role to decrease or inhibit development of aortic valve calcification.

Background: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large‐scale study aimed to retrospectively evaluate the long‐term outcomes of the patients who underwent reoperation or TC of PVLs. Methods and Results: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary end point was defined as the all‐cause death during follow‐up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P =0.549) and procedural success (73.7 versus 65.2%; P =0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in‐hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75–5.88]; P =0.001; and adjusted odds ratio (inverse probability‐weighted), 4.55 [95% CI, 2.27–10.0]; P <0.001). However, the long‐term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59–1.25]; P =0.435; and adjusted HR (inverse probability‐weighted), 1.11 [95% CI, 0.67–1.81]; P =0.679). Conclusions: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long‐term mortality rates compared with surgery.