Disha Kushtrim, Rouman Mina, Secknus Maria-Anna, Kuntze Thomas, Girdauskas Evaldas
Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany
Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany.
Interact Cardiovasc Thorac Surg. 2016 Apr;22(4):465-71. doi: 10.1093/icvts/ivv387. Epub 2016 Jan 23.
Bicuspid aortic valve (BAV)-associated aortopathy has been proposed to progress after isolated aortic valve replacement (AVR) surgery, which has been traditionally used as an argument against a TAVR procedure in this clinical subset. Still, more than half of BAV patients have a normal-sized proximal aorta at the time of AVR surgery. We aimed to analyse the long-term risk of adverse aortic events after isolated conventional AVR surgery for BAV and normal-sized proximal aorta.
A total of 200 consecutive patients (mean age 56 ± 13 years, 73% men) with BAV disease and ascending aortic diameter of <40 mm underwent isolated conventional AVR from 1995 through 2008 and were identified from our institutional BAV database. Long-term follow-up data (a total of 1532 patient-years) were obtained for all hospital survivors. Composite adverse aortic/cardiovascular events were defined as the need for redo aortic surgery, the occurrence of aortic dissection/rupture, or sudden cardiac death during follow-up.
A total of 25 (13%) patients died after a mean follow-up of 8.5 ± 5 years post-AVR surgery, which resulted in an overall survival rate of 75 ± 6 and 87 ± 7% at 15 years postoperatively, for BAV-aortic stenosis and BAV-aortic regurgitation, respectively (P = 0.6). An adverse aortic event occurred in 1 (0.5%) study patient, while 5 (2.5%) further patients suffered sudden cardiac death. Only 1 patient required redo aortic surgery. No documented aortic dissection/rupture occurred. Redo AVR surgery due to endocarditis or structural valve degeneration was performed in 6 (3%) patients. The rate of freedom from composite adverse events was 92 ± 5 and 95 ± 4% at 15 years, for the AS and AR subgroups, respectively (P = 0.7).
BAV patients with aortic valve dysfunction and normal-sized ascending aorta are at considerably low risk of late adverse aortic events after isolated AVR.
有人提出，二叶式主动脉瓣（BAV）相关的主动脉病变在单纯主动脉瓣置换（AVR）手术后会继续发展，传统上这被用作反对在这一临床亚组中进行经导管主动脉瓣置换术（TAVR）的理由。然而，超过一半的BAV患者在接受AVR手术时近端主动脉大小正常。我们旨在分析单纯传统AVR手术治疗BAV且近端主动脉大小正常后的主动脉不良事件的长期风险。
1995年至2008年期间，共有200例连续的BAV疾病患者（平均年龄56±13岁，73%为男性），升主动脉直径<40mm，接受了单纯传统AVR手术，并从我们机构的BAV数据库中识别出来。获得了所有医院幸存者的长期随访数据（总共1532患者年）。复合主动脉/心血管不良事件定义为随访期间再次进行主动脉手术的必要性、主动脉夹层/破裂的发生或心源性猝死。
平均AVR手术后8.5±5年，共有25例（13%）患者死亡，BAV主动脉瓣狭窄和BAV主动脉瓣关闭不全患者术后15年的总生存率分别为75±6%和87±7%（P = 0.6）。1例（0.5%）研究患者发生了主动脉不良事件，另有5例（2.5%）患者死于心源性猝死。只有1例患者需要再次进行主动脉手术。没有记录到主动脉夹层/破裂的发生。6例（3%）患者因感染性心内膜炎或人工瓣膜结构退化进行了再次AVR手术。AS和AR亚组在15年时无复合不良事件的发生率分别为92±5%和95±4%（P = 0.7）。
主动脉瓣功能障碍且升主动脉大小正常的BAV患者在单纯AVR术后发生晚期主动脉不良事件的风险相当低。
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