Esaki Jiro, Leshnower Bradley G, Binongo Jose N, Lasanajak Yi, McPherson LaRonica, Halkos Michael E, Guyton Robert A, Chen Edward P
Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan.
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Ann Thorac Surg. 2016 Nov;102(5):1522-1530. doi: 10.1016/j.athoracsur.2016.04.091. Epub 2016 Jun 25.
Valve-sparing root replacement (VSRR) is an attractive therapy for aortic root aneurysms; however, there is a paucity of data comparing VSRR with conventional root replacement using a mechanical valve-conduit (MECH). This study evaluates and compares outcomes of VSRR and MECH.
A retrospective review from 2002 to 2015 at a US academic center identified 444 patients who underwent VSRR (282 patients) or MECH (162 patients). Propensity score matching was performed, based on 22 preoperative and intraoperative characteristics, and 87 matched pairs were identified.
There was no difference in mean age between the groups (VSRR 45.0 years, MECH 44.2 years, p = 0.59). The incidence of Marfan syndrome (VSRR 10.3%, MECH 12.6%, p = 0.63), type A acute aortic dissection (VSRR 25.3%, MECH 27.6%, p = 0.73), reoperation (VSRR 23.0%, MECH 21.8%, p = 0.86), and arch replacement (VSRR 54.0%, MECH 52.9%, p = 0.88) were similar in both groups. Ejection fraction was similar (VSRR 52.8% ± 10.9%, MECH 52.4% ± 11.7%, p = 0.83). Operative mortality was 2.3% with VSRR and 8.0% with MECH (p = 0.10). There were no significant differences in renal failure requiring dialysis (VSRR 1.1%, MECH 4.6%, p = 0.24), permanent neurologic dysfunction (VSRR 2.3%, MECH 6.9%, p = 0.16), and pacemaker implantation (VSRR 1.1%, MECH 1.1%, p = 0.99) between the groups. Survival at 7 years was significantly improved in patients who underwent VSSR (VSRR 85.5%, MECH 73.6%, p = 0.03).
In comparison with patients undergoing MECH, there is improved midterm survival among patients undergoing VSRR, with similar operative mortality and morbidity. For appropriately selected patients, VSRR provides an attractive and potentially superior alternative to MECH.
保留瓣膜的主动脉根部置换术（VSRR）是治疗主动脉根部瘤的一种有吸引力的疗法；然而，将VSRR与使用机械瓣膜管道的传统根部置换术（MECH）进行比较的数据很少。本研究评估并比较了VSRR和MECH的治疗效果。
对美国一家学术中心2002年至2015年的病例进行回顾性分析，确定了444例行VSRR（282例）或MECH（162例）的患者。根据22项术前和术中特征进行倾向评分匹配，共确定了87对匹配病例。
两组患者的平均年龄无差异（VSRR组45.0岁，MECH组44.2岁，p = 0.59）。马凡综合征的发生率（VSRR组10.3%，MECH组12.6%，p = 0.63）、A型急性主动脉夹层的发生率（VSRR组25.3%，MECH组27.6%，p = 0.73）、再次手术率（VSRR组23.0%，MECH组21.8%，p = 0.86）和主动脉弓置换率（VSRR组54.0%，MECH组52.9%，p = 0.88）在两组中相似。射血分数相似（VSRR组52.8%±10.9%，MECH组52.4%±11.7%，p = 0.83）。VSRR组的手术死亡率为2.3%，MECH组为8.0%（p = 0.10）。两组在需要透析的肾衰竭发生率（VSRR组1.1%，MECH组4.6%，p = 0.24）、永久性神经功能障碍发生率（VSRR组2.3%，MECH组6.9%，p = 0.16）和起搏器植入率（VSRR组1.1%，MECH组1.1%，p = 0.99）方面无显著差异。接受VSSR的患者7年生存率显著提高（VSRR组85.5%，MECH组73.6%，p = 0.03）。
与接受MECH的患者相比，接受VSRR的患者中期生存率有所提高，手术死亡率和发病率相似。对于适当选择的患者，VSRR是一种有吸引力且可能更优的替代MECH的方法。
