Tamer Saadallah, Mastrobuoni Stefano, Momeni Mona, Aphram Gaby, Navarra Emiliano, Poncelet Alain, Noirhomme Philippe, Astarci Parla, El Khoury Gebrine, de Kerchove Laurent
Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain and Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Division of Anesthesiologyy, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Indian J Thorac Cardiovasc Surg. 2020 Jan;36(Suppl 1):71-80. doi: 10.1007/s12055-019-00842-x. Epub 2019 Aug 9.
To analyze our long-term experience with valve-sparing reimplantation technique in treating aortic root aneurysm, aortic regurgitation, and aortic dissection in patients with tricuspid aortic valve.
Between March 1998 and October 2018, 303 consecutive patients underwent valve-sparing reimplantation in our institution. The mean age of this cohort was 52.9 ± 15 years. Time to event analysis was performed with the Kaplan-Meier method. Risk of death, reoperation, and aortic regurgitation (AR) recurrence were analyzed using the cox-regression method.
In-hospital mortality was 1% ( = 3) of which two were admitted for acute aortic dissection. Median follow-up was 5.81 years ([IQR]: 2.8-10 years). Thirty-nine patients (14.4%) died during follow-up. At 5 and 10 years, overall survival was 92 ± 2%and 75 ± 4.9%, respectively. Seventeen patients required late aortic valve reoperation. Freedom from valve reoperation was 95 ± 2% and 90 ± 3%. Freedom from AR > 2+ and AR > 1+ at 10 years was 91 ± 4% and 71.5 ± 4.6%, respectively. Significant multivariate predictors of death included age, New York Heart Association dyspnea class (NYHA), type A acute dissection (TAAD), and preoperative left ventricular end-diastolic diameter (LVEDD). Significant multivariate predictors of AR recurrence included indication for surgery, previous cardiac surgery, and presence of preoperative AR. Freedom from events like major bleeding, thromboembolic events, and infective endocarditis at 10 years were 97%, 98%, and 96%, respectively.
Aortic valve-sparing with the reimplantation technique has been performed for over two decades in our institution, and the results in patients with tricuspid aortic valve (TAV) are excellent in terms of survival and freedom from valve-related adverse outcomes including valve reoperation. These results continue supporting the use of valve sparing root replacement using the reimplantation technique (VSRR) in patients with aortic aneurysm, irrespective of whether they have preoperative AR or not. VSRR is safe, durable, and reproducible, but further follow-up, well into the second decade is still necessary.
分析我们采用保留瓣膜再植入技术治疗三尖瓣主动脉瓣患者的主动脉根部瘤、主动脉瓣反流和主动脉夹层的长期经验。
1998年3月至2018年10月期间，我们机构连续303例患者接受了保留瓣膜再植入手术。该队列的平均年龄为52.9±15岁。采用Kaplan-Meier方法进行事件发生时间分析。使用Cox回归方法分析死亡、再次手术和主动脉瓣反流（AR）复发的风险。
住院死亡率为1%（n=3），其中2例因急性主动脉夹层入院。中位随访时间为5.81年（[四分位间距]：2.8 - 10年）。39例患者（14.4%）在随访期间死亡。在5年和10年时，总生存率分别为92±2%和75±4.9%。17例患者需要晚期主动脉瓣再次手术。无瓣膜再次手术率为95±2%和90±3%。10年时无AR>2+和AR>1+的发生率分别为91±4%和71.5±4.6%。死亡的显著多因素预测因素包括年龄、纽约心脏协会呼吸困难分级（NYHA）、A型急性夹层（TAAD）和术前左心室舒张末期直径（LVEDD）。AR复发的显著多因素预测因素包括手术指征、既往心脏手术和术前AR的存在。10年时无大出血、血栓栓塞事件和感染性心内膜炎等事件的发生率分别为97%、98%和96%。
我们机构采用保留瓣膜再植入技术已超过二十年，对于三尖瓣主动脉瓣（TAV）患者，在生存以及避免包括瓣膜再次手术在内的瓣膜相关不良结局方面结果优异。这些结果继续支持对主动脉瘤患者使用保留瓣膜根部置换的再植入技术（VSRR），无论他们术前是否有AR。VSRR安全、持久且可重复，但仍需要进一步随访至第二个十年。
