Kari Fabian A, Doll Kai-Nicolas, Hemmer Wolfgang, Liebrich Markus, Sievers Hans-Hinrich, Richardt Doreen, Reichenspurner Hermann, Detter Christian, Siepe Matthias, Czerny Martin, Beyersdorf Friedhelm
Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany
Sana Heart Surgery Stuttgart, Stuttgart, Germany.
Interact Cardiovasc Thorac Surg. 2016 Apr;22(4):431-8. doi: 10.1093/icvts/ivv354. Epub 2015 Dec 30.
The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort.
Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors.
The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement.
Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.
本研究旨在对多中心队列中保留瓣膜主动脉根部置换术（V-SARR）后的死亡率和主动脉瓣置换情况进行特征分析。
1994年至2014年间，德国吕贝克（n = 343，34%）、斯图加特（n = 346，34%）、汉堡（n = 109，11%）和弗赖堡（n = 217，21%）的中心有1015例患者接受了V-SARR，其中288例（28%）进行了瓣叶/瓣环修复，727例（72%）未进行修复。计算年龄和性别匹配的普通人群的相对生存率。采用对数秩检验和多因素逻辑回归分析来确定危险因素。
平均随访时间为5.2±3.9年。累计随访时间为2933患者年。早期生存率为98%。纽约心脏协会（NYHA）心功能分级和动脉瘤大小是中期随访期间死亡的预测因素（P = 0.025）。8年时无需主动脉瓣置换的比例为90%，V-SARR的类型（根部重塑、David II型）是一个危险因素（P = 0.015）。二叶式主动脉瓣（P = 0.26）和初始瓣膜功能（P = 0.4）对再次手术无影响。是否需要额外的瓣膜修复（瓣叶/瓣环）与再次手术无关：进行瓣叶修复的患者8年时无需主动脉瓣置换的比例为84%，仅进行V-SARR的患者为90%（P = 0.218）。马凡综合征对生存率或主动脉瓣置换无影响。
V-SARR术后患者的中期生存率与匹配的普通人群相当。反流性二叶式主动脉瓣是V-SARR的有利适应证。应在出现症状或大动脉瘤之前进行预防性手术，以实现最佳的中期治疗效果。
