Gökalp Arjen L, de Heer Frederiek, Etnel Jonathan R G, Kluin Jolanda, Takkenberg Johanna J M
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Amsterdam University Medical Center, Amsterdam, The Netherlands.
Ann Cardiothorac Surg. 2019 May;8(3):372-382. doi: 10.21037/acs.2019.04.07.
Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross procedure-survival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.
为65岁以下（即非老年患者）的主动脉瓣或主动脉根部疾病患者选择最佳手术治疗策略仍然具有挑战性。本研究的目的是总结当代关于非老年患者主动脉瓣置换术（AVR）和主动脉根部手术后临床及生活质量结果的研究。最近关于生物瓣和机械瓣AVR、Ross手术及主动脉根部手术后临床结果的系统评价表明，任何类型的AVR或主动脉根部手术后事件发生率都相当高，且除Ross手术外，生存率并不理想。虽然机械瓣AVR和根部手术后血栓栓塞和出血事件更常见，但这些事件在生物瓣AVR、Ross手术和保留瓣膜主动脉根部手术（VSRR）后也相当常见。同样，生物瓣AVR、Ross手术和VSRR后再次手术更常见，但机械瓣AVR和根部置换后也频繁发生。AVR患者的已发表证据表明，生物瓣解决方案在与健康相关的生活质量（HRQoL）结果方面更好，而主动脉根部手术后的HRQoL有限且相互矛盾。本综述表明，对于非老年主动脉瓣和主动脉根部疾病患者的治疗需要根据个体患者进行调整，将临床和HRQoL结果视为做出最能反映患者价值观和生活目标的治疗决策的关键因素。
