Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia.
Ann Thorac Surg. 2019 Feb;107(2):499-504. doi: 10.1016/j.athoracsur.2018.08.011. Epub 2018 Oct 4.
Standard therapy for aortic root dilation in the setting of bicuspid aortic valves remains use of a composite valve conduit. The long-term durability of valve-sparing root replacement (VSRR) in bicuspid aortopathy is presently unclear. In this study, the midterm results of performing VSRR in the setting of a bicuspid valve was analyzed.
A single institutional database identified 280 patients who underwent VSRR from 2005 to 2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a bicuspid aortic valve with aortic insufficiency (AI). Patients were followed prospectively and had annual echocardiograms.
The average age in this series was 42 ± 11 years. Eighty percent were men and 33% had New York Heart Association class III to IV symptoms. More than 2+ AI was present in 42% of patients preoperatively. The incidence of operative death, stroke, and renal failure was 0%. Mean follow-up was 39 ± 30 months. At latest follow-up, 62% of patients had zero AI and 87% of patients had <1+ AI. At 5 years, freedom from >2+ AI was 97% and freedom from AVR was 96%. Preoperative AI was not found to be a significant risk factor for postoperative >2+ AI (p = 0.61) or AVR (p = 0.61).
VSRR can be safely and effectively performed in young patients with bicuspid valve anatomy regardless of degree of preoperative AI. Valve function is durable and the incidence of valve-related complications is low. VSRR is an attractive and potentially superior option to conventional root replacement in appropriately selected patients with bicuspid aortopathy.
在二叶式主动脉瓣的情况下，治疗主动脉根部扩张的标准疗法仍然是使用复合瓣环。目前尚不清楚二叶式主动脉瓣病变行保留瓣膜的根部替换术（VSRR）的长期耐久性。本研究分析了在二叶式主动脉瓣病变的情况下行 VSRR 的中期结果。
一个单一的机构数据库确定了 280 例从 2005 年至 2016 年期间行 VSRR 的患者。对 60 例在二叶式主动脉瓣伴主动脉瓣关闭不全（AI）的情况下行 VSRR 的连续患者进行了结果分析。患者前瞻性随访，并进行每年的超声心动图检查。
本系列患者的平均年龄为 42±11 岁。80%为男性，33%有纽约心脏协会心功能 III 至 IV 级症状。42%的患者术前存在 2+以上 AI。手术死亡率、中风和肾衰竭的发生率为 0%。平均随访 39±30 个月。最近一次随访时，62%的患者 AI 为 0，87%的患者 AI 为<1+。5 年时，无>2+AI 的生存率为 97%，无主动脉瓣置换术（AVR）的生存率为 96%。术前 AI 并不是术后>2+AI（p=0.61）或 AVR（p=0.61）的显著危险因素。
VSRR 可安全有效地应用于二叶式瓣叶解剖结构的年轻患者，无论术前 AI 程度如何。瓣膜功能持久，瓣膜相关并发症发生率低。在适当选择的二叶式主动脉瓣病变患者中，VSRR 是一种有吸引力且潜在更优的选择。
