Girdauskas Evaldas, Disha Kushtrim, Espinoza Andres, Misfeld Martin, Reichenspurner Hermann, Borger Michael A, Kuntze Thomas
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany -
Department of Cardiac Surgery, Heart Center, Central Hospital of Bad Berka, Bad Berka, Germany.
J Cardiovasc Surg (Torino). 2017 Jun;58(3):473-480. doi: 10.23736/S0021-9509.16.09311-3. Epub 2016 Mar 24.
Regurgitant bicuspid aortic valves (BAV) are reported to be associated with myxomatous degeneration of the anterior mitral leaflet. We examined the risk of late new-onset mitral regurgitation (MR) in patients who underwent aortic valve/aortic root surgery for BAV regurgitation and concomitant root dilatation.
A total of 97 consecutive patients (47±11 years, 94% men) were identified from our institutional BAV database (N.=640) based on the following criteria: 1) BAV regurgitation; 2) aortic root diameter >40 mm; 3) no relevant mitral valve disease (i.e., MR<2+) and no simultaneous mitral intervention at the time of BAV surgery. All patients underwent isolated aortic valve replacement (AVR subgroup, N.=59) or aortic root replacement with a composite graft (i.e., for root aneurysm >50 mm) (ARR subgroup, N.=38) from 1995 through 2008. Echocardiographic follow-up (1009 patient-years) was obtained for all 96 (100%) hospital survivors. The primary endpoint was freedom from new-onset MR>2+ and redo mitral valve surgery.
Nine patients (9.4%) showed new-onset MR>2+ after mean echocardiographic follow-up of 10.4±4.0 years postoperatively. Myxomatous degeneration and prolapse of the anterior mitral leaflet was found in all 9 patients, and the posterior leaflet was involved in 3 of them. Two patients (2%) in AVR subgroup underwent re-do mitral surgery. No MR>2+ occurred in ARR subgroup. Freedom from MR>2+ or mitral surgery at 15 years was significantly lower in AVR subgroup vs. ARR subgroup (i.e., 38% vs. 100%, P=0.01).
The risk of new-onset MR is significantly increased in patients with BAV regurgitation and aortic root dilatation who undergo isolated AVR rather than root replacement. The mechanism by which aortic root replacement may prevent the occurrence of late MR in BAV root phenotype patients is to be determined.
据报道，反流性二叶式主动脉瓣（BAV）与二尖瓣前叶黏液样变性有关。我们研究了因BAV反流及合并根部扩张而接受主动脉瓣/主动脉根部手术的患者发生晚期新发二尖瓣反流（MR）的风险。
基于以下标准，从我们机构的BAV数据库（N = 640）中确定了97例连续患者（47±11岁，94%为男性）：1）BAV反流；2）主动脉根部直径>40 mm；3）无相关二尖瓣疾病（即MR<2+）且在BAV手术时未同时进行二尖瓣干预。从1995年至2008年，所有患者均接受了单纯主动脉瓣置换术（AVR亚组，N = 59）或使用复合移植物进行主动脉根部置换术（即对于根部动脉瘤>50 mm）（ARR亚组，N = 38）。对所有96例（100%）住院幸存者进行了超声心动图随访（1009患者年）。主要终点是无新发MR>2+且无需再次进行二尖瓣手术。
在术后平均10.4±4.0年的超声心动图随访后，9例患者（9.4%）出现新发MR>2+。所有9例患者均发现二尖瓣前叶黏液样变性和脱垂，其中3例累及后叶。AVR亚组中有2例患者（2%）接受了再次二尖瓣手术。ARR亚组中未发生MR>2+。AVR亚组与ARR亚组相比，15年时无MR>2+或二尖瓣手术的生存率显著降低（即38%对100%，P = 0.01）。
对于BAV反流和主动脉根部扩张的患者，接受单纯AVR而非根部置换时，新发MR的风险显著增加。主动脉根部置换术可预防BAV根部表型患者发生晚期MR的机制有待确定。
