Vallabhajosyula Prashanth, Szeto Wilson Y, Habertheuer Andreas, Komlo Caroline, Milewski Rita K, McCarthy Fenton, Desai Nimesh D, Bavaria Joseph E
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2016 Oct;102(4):1221-8. doi: 10.1016/j.athoracsur.2016.03.087. Epub 2016 Jun 1.
In patients with a bicuspid aortic valve presenting with aortic insufficiency (AI) and root aneurysm, we assessed whether outcomes with primary cusp repair with root reimplantation were equivalent to the gold standard Bentall procedures.
From 2002 to 2014, 710 patients with bicuspid aortic valve underwent aortic root procedures. Of these, only patients presenting with noncalcified type I bicuspid aortic valve with AI (n = 165) were included to maintain anatomic and physiologic homogeneity between the groups. Aortic stenosis, endocarditis, redo root, and emergency cases were excluded. Patients undergoing valve-sparing root reimplantation (VSRR group, n = 45) were retrospectively compared with those undergoing Bentall root replacement (Bentall group, n = 120).
Patients in the Bentall group were older (52 ± 13 vs 46 ± 12 years; p ≤ 0.01) and had a lower ejection fraction (0.53 ± 0.12 versus 0.58 ± 0.08; p < 0.01), but left ventricular diastolic diameter was similar (58 ± 10 mm versus 57 ± 9 mm; p = 0.5). Thirty-day and in-hospital mortality was zero; in-hospital stroke rate was 0.8% (n = 1) in the Bentall group (0 in the VSRR group; p = 0.54). Permanent pacemaker rate was 6% (n = 7) in the Bentall group (0 in the VSRR group; p = 0.2). On discharge echocardiography, AI grade ≤ 1+ (100%; p = 1) and transvalvular gradients (mean gradient 7 ± 3 versus 6 ± 3 mm Hg; p = 0.14) were similar. Mean follow-up was 7.5 ± 3.2 and 3.4 ± 2.9 years (p < 0.001). There were 14 transient ischemic attacks or stroke events in the Bentall group, and none in the VSRR group. One patient in each group exhibited AI ≥ 3+. Five-year actuarial survival (100% versus 98% ± 2%; p = 0.8) and freedom from aortic reoperation (98% ± 2% versus 100%; p = 0.8) were similar.
In patients with bicuspid aortic valve AI with root aneurysm, primary cusp repair with root reimplantation achieves equivalent midterm outcomes compared with Bentall root replacement.
在患有主动脉瓣关闭不全（AI）和根部动脉瘤的二叶式主动脉瓣患者中，我们评估了采用根部再植入术进行原发性瓣叶修复的效果是否等同于金标准Bentall手术。
2002年至2014年期间，710例二叶式主动脉瓣患者接受了主动脉根部手术。其中，仅纳入了患有非钙化I型二叶式主动脉瓣合并AI的患者（n = 165），以保持两组之间的解剖学和生理学同质性。排除主动脉狭窄、心内膜炎、再次进行根部手术以及急诊病例。对接受保留瓣膜根部再植入术的患者（VSRR组，n = 45）与接受Bentall根部置换术的患者（Bentall组，n = 120）进行回顾性比较。
Bentall组患者年龄较大（52±13岁对46±12岁；p≤0.01），射血分数较低（0.53±0.12对0.58±0.08；p<0.01），但左心室舒张直径相似（58±10mm对57±9mm；p = 0.5）。30天和住院死亡率为零；Bentall组住院卒中发生率为0.8%（n = 1）（VSRR组为0；p = 0.54）。Bentall组永久起搏器置入率为6%（n = 7）（VSRR组为0；p = 0.2）出院时超声心动图检查显示，AI分级≤1+（100%；p = 1）和跨瓣压差（平均压差7±3对6±3mmHg；p = 0.14）相似。平均随访时间分别为7.5±3.2年和3.4±2.9年（p<0.001）。Bentall组有14例短暂性脑缺血发作或卒中事件，VSRR组无。每组各有1例患者AI≥3+。5年精算生存率（分别为100%对98%±2%；p = 0.8）和免于再次主动脉手术的概率（98%±2%对100%；p = 0.8）相似。
在患有二叶式主动脉瓣AI合并根部动脉瘤的患者中，采用根部再植入术进行原发性瓣叶修复与Bentall根部置换术相比，中期效果相当。
