Background/Purpose: Aortic valve (AV) surgery is often performed for aortic regurgitation (AR) in patients with Takayasu arteritis (TA). However, data on the long-term outcomes, including survival and cardiac and cerebrovascular outcome, are lacking. This study aimed to characterize the long-term outcomes and prognostic factors of TA patients who underwent surgery for AR.

Methods: Medical records of patients with TA who underwent surgery for moderate to severe AR between January 1995 and December 2015 were reviewed. Poor outcomes were defined as all-cause death and major adverse cardiac and cerebrovascular events (MACCE) including life-threatening aortic aneurysm. Overall survival (OS) was presented with the Kaplan-Meier method and risk factors for poor outcome were analyzed with multivariate Cox analysis.

Results: Total 35 patients with TA with AR underwent AV surgery. The mean age of the patients (male 5, female 30) was 47.2±13 years and the mean follow-up duration was 107.9±85.7 months (median, 97 months; interquartile range, 44-150). Inflammatory values (ESR 36.9±30.6mm/h, CRP 3.4±4.9mg/dL) were elevated and 25 of total 35 patients (71%) received perioperative steroid therapy. The 5-year OS rate of the patients was 85.4% and the 5-year MACCE free survival rate was 73.9% (OS rate; 68.1%, MACCE free survival; 46.6% at 10-year). Eighteen of 35 patients (51.4%) had a poor outcome during follow-up. Re-operation was needed in eleven patients (11/35, 31.4%) and stroke occurred in three patients (3/35, 8.6%). Hata angiographic classification type V (6/17 [35.3%] vs 10/18 [55.6%], p = 0.036) and coronary disease (0/17 [0%] vs 4/18[22.2%], p=0.030) were significantly more frequent in patients with poor outcome. Multivariate analysis revealed that coronary disease (hazard ratio [HR], 4.665; 95% confidence interval [CI], 1.252-17.385; p = 0.022), diagnosis of TA before the age of 40 (HR, 3.909; 95% CI, 1.221-12.517; p = 0.022) were significantly associated with development of poor outcomes (Table 1).

Conclusion: In patients with TA with surgery for AR, poor cardiovascular outcome was frequently observed during follow-up period. It was associated with concomitant coronary artery disease, and TA diagnosis before the age of 40.

Table 1. Multivariate analysis of predictive factors of poor outcomes in patients with Takayasu arteritis with surgery for aortic regurgitation.

CI: confidence interval; HR: hazard ratio; TA: Takayasu arteritis

^¶coronary disease: severity is more than moderate stenosis (minimal: 1-24%, mild: 25-49% moderate: 50-69%, severe> 70%)

ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-outcome-and-prognostic-factors-after-aortic-valve-surgery-due-to-aortic-valve-regurgitation-in-patients-with-takayasu-arteritis/