Wu Jinlin, Huang Yan, Qiu Juntao, Saeed Bilal, Yu Cuntao
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
Interact Cardiovasc Thorac Surg. 2019 Nov 1;29(5):766-775. doi: 10.1093/icvts/ivz180.
There are conflicting views regarding the status of valve-sparing root replacement (VSRR) as a proper treatment for acute type A aortic dissection (AAAD). Our goal was to compare the early and late outcomes of VSRR versus those of the Bentall procedure in patients with AAAD.
We performed a systematic review and meta-analysis of 9 studies to compare the outcomes of VSRR with those of the Bentall procedure in patients with AAAD. We focused on the following issues: early and late mortality rates, re-exploration, thromboembolization/bleeding events, infective endocarditis and reintervention rates.
A total of 706 patients with AAAD who underwent aortic root surgery were analysed; 254 patients were treated with VSRR and 452 with the Bentall procedure. VSRR was associated with a reduced risk of early death [odds ratio (OR) 0.34; 95% confidence interval (CI) 0.21-0.57] and late death (OR 0.34; 95% CI 0.21-0.57) compared with the Bentall procedure. No statistically significant difference was observed between the VSRR and Bentall groups with pooled ORs (OR 0.77; 95% CI 0.47-1.27, OR 0.61; 95% CI 0.32-1.18 and OR 0.71; 95% CI 0.23-2.15) for re-exploration, thromboembolization/bleeding and postoperative infective endocarditis, respectively. An increased risk of reintervention was observed for the VSRR compared to the Bentall group (OR 3.79; 95% CI 1.27-11.30). The pooled rate of reintervention incidence was 1.6% (95% CI 0.0-3.7%) and 0.4% (95% CI 0.0-1.3%) for the VSRR and the Bentall groups, respectively.
VSRR in patients with AAAD can be performed in experienced centres with excellent short- and long-term outcomes compared to those with the Bentall procedure and thus should be recommended especially for active young patients.
关于保留瓣膜的主动脉根部置换术（VSRR）作为急性A型主动脉夹层（AAAD）的一种合适治疗方法的地位，存在相互矛盾的观点。我们的目标是比较AAAD患者中VSRR与Bentall手术的早期和晚期结果。
我们对9项研究进行了系统评价和荟萃分析，以比较AAAD患者中VSRR与Bentall手术的结果。我们关注以下问题：早期和晚期死亡率、再次手术探查、血栓栓塞/出血事件、感染性心内膜炎和再次干预率。
共分析了706例接受主动脉根部手术的AAAD患者；254例接受VSRR治疗，452例接受Bentall手术治疗。与Bentall手术相比，VSRR与早期死亡风险降低[比值比（OR）0.34；95%置信区间（CI）0.21 - 0.57]和晚期死亡风险降低（OR 0.34；95%CI 0.21 - 0.57）相关。VSRR组和Bentall组在再次手术探查、血栓栓塞/出血和术后感染性心内膜炎的合并OR值（分别为OR 0.77；95%CI 0.47 - 1.27、OR 0.61；95%CI 0.32 - 1.18和OR 0.71；95%CI 0.23 - 2.15）方面未观察到统计学上的显著差异。与Bentall组相比，VSRR组再次干预的风险增加（OR 3.79；95%CI 1.27 - 11.30）。VSRR组和Bentall组再次干预发生率的合并率分别为1.6%（95%CI 0.0 - 3.7%）和0.4%（95%CI 0.0 - 1.3%）。
与Bentall手术相比，经验丰富的中心对AAAD患者进行VSRR可获得优异的短期和长期结果，因此尤其应推荐给年轻的活跃患者。
