Puehler Thomas, Freitag-Wolf Sandra, Friedrich Christine, Salem Mohamed, Renner Jochen, Cremer Joachim, Haneya Assad
Klinik für Herz- und Gefäßchirurgie, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.
Institute of Medical Informatics and Statistics, Universitatsklinikum Schleswig-Holstein Campus Kiel, Kiel, Schleswig-Holstein, Germany.
Thorac Cardiovasc Surg. 2020 Jun;68(4):301-308. doi: 10.1055/s-0039-1683425. Epub 2019 Mar 28.
Therapy of complex aortic root pathologies remains a great surgical challenge. Though different graft materials are available to replace the often-destroyed aortic root, long durability and freedom from reoperation of the latter are still under debate. The aim of our study was to investigate patients' postoperative outcome after implantation of the BioIntegral conduit in complex aortic root pathologies.
From February 2014 to May 2017, 33 consecutive patients (69.7% male) with a median age of 73 (57.5; 76.2) years underwent aortic root replacement with the BioIntegral conduit at our institution. Severe aortic valve endocarditis (78.8%) was the predominant indication for surgery. In 28 patients (84.9%), implantation was performed as redo or in 87.8% as urgent and emergent surgery. Primary end-point was the 30-day survival time, evaluated by Cox regression analysis. Secondary midterm outcome and graft-related reoperation were analyzed.
Median follow-up for all patients was 178 (8; 659) days. Median EuroScore II was 19.9% (13.4; 29.9). Freedom from reoperation was 97%. The overall 30-day mortality rate was 33% mainly caused by multiorgan failure in six (18.2%) patients and cardiac failure in five (15.1%) patients. One further death occurred during follow-up at day 156. None was directly conduit-related. Graft reinfection after the 4th surgery with basal abscess formation occurred in only one patient (3%). Early echocardiographic assessment of the valve revealed good functional results. A higher EuroScore II was significantly associated with a poorer 30-day survival time (hazard ratio, 1.039; 95% confidence interval, 1.015-1.063, = 0.001).
Aortic root replacement for complex pathologies is associated with substantial 30-day mortality, but survival of patients after discharge from hospital was stable. Early functional status of the BioIntegral valve was good. Though freedom from re-operation was low, long-term outcome and long-term functional status have to be further evaluated.
复杂主动脉根部病变的治疗仍然是一项巨大的外科挑战。尽管有不同的移植材料可用于替换常常遭到破坏的主动脉根部，但后者的长期耐用性和无需再次手术的特性仍存在争议。我们研究的目的是调查在复杂主动脉根部病变中植入生物整合导管后患者的术后结局。
2014年2月至2017年5月，我们机构连续33例患者（男性占69.7%）接受了生物整合导管主动脉根部置换术，中位年龄为73（57.5；76.2）岁。严重主动脉瓣心内膜炎（78.8%）是手术的主要指征。28例患者（84.9%）进行了再次手术，87.8%为急诊和紧急手术。主要终点是30天生存时间，通过Cox回归分析进行评估。分析了中期次要结局和与移植物相关的再次手术情况。
所有患者的中位随访时间为178（8；659）天。欧洲心脏手术风险评估系统（EuroScore）II中位数为19.9%（13.4；29.9）。无需再次手术的比例为97%。30天总体死亡率为33%，主要原因是6例（18.2%）患者出现多器官功能衰竭，5例（15.1%）患者出现心力衰竭。随访期间在第156天又有1例死亡。无一例与导管直接相关。仅1例患者（3%）在第4次手术后出现移植物再感染并伴有基底脓肿形成。早期超声心动图评估瓣膜显示功能良好。较高的EuroScore II与较差的30天生存时间显著相关（风险比，1.039；95%置信区间，1.015 - 1.063，P = 0.001）。
复杂病变的主动脉根部置换术与较高的30天死亡率相关，但出院后患者的生存率稳定。生物整合瓣膜的早期功能状态良好。尽管无需再次手术的比例较低，但长期结局和长期功能状态仍需进一步评估。
