Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Thorac Cardiovasc Surg. 2022 Jun;70(4):289-296. doi: 10.1055/s-0040-1722197. Epub 2021 Jan 19.
The aim of this study is to test if the newly proposed 45 mm size criterion for ascending aortic replacement (AAR) in bicuspid aortic valve (BAV) patients undergoing aortic valve replacement (AVR) is predictive of improved early outcomes.
Data of 306 BAV patients with an aortic diameter of ≥45 mm undergoing AVR alone or with AAR were retrospectively analyzed. Patients were divided into groups of AVR + AAR ( = 220) and AVR only ( = 86) based on if surgery was performed according to the 45 mm criterion. End point was early adverse events, including 30-day and in-hospital mortality, cardiac events, acute renal failure, stroke, and reoperation for bleeding. Cox regression was used to assess if conformance to 45 mm criterion could predict fewer early adverse events.
AVR + AAR group had significantly higher postoperative left ventricular ejection fraction (LVEF) (0.59 ± 0.09 vs. 0.55 ± 0.11, = 0.006) and longer cardiopulmonary bypass (CPB) time (128 vs. 111 minutes, = 0.002). Early adverse events occurred in 45 patients (14.7%), which was more prevalent in the AVR-only group (22.1% vs. 11.8%, = 0.020). Conformance to the 45 mm criterion predicted lower rate of early adverse events (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.28-0.98, = 0.042). After adjustment for gender, age, AAo diameter, sinuses of Valsalva diameter, preoperative LVEF, Sievers subtypes, BAV valvulopathy, and CPB and cross-clamp times, conformance to the 45 mm size criterion still predicted lower incidence of early adverse events (HR: 0.37, 95% CI: 0.15-0.90, = 0.028).
This study shows that conformance to 45 mm size cutoff for preemptive AAR during aortic valve replacement in patients with BAV was not associated with increased risk for adverse events and may improve early surgical outcomes.
本研究旨在验证对于行主动脉瓣置换术（AVR）的二叶式主动脉瓣（BAV）患者，新提出的 45mm 升主动脉置换（AAR）尺寸标准是否可预测早期结局改善。
回顾性分析了 306 例主动脉直径≥45mm 的 BAV 患者的数据，这些患者接受了单纯 AVR 或 AVR 联合 AAR。根据手术是否符合 45mm 标准，将患者分为 AVR+AAR 组（ = 220）和单纯 AVR 组（ = 86）。终点是早期不良事件，包括 30 天和住院死亡率、心脏事件、急性肾功能衰竭、卒中和再次出血手术。Cox 回归用于评估符合 45mm 标准是否可预测较少的早期不良事件。
AVR+AAR 组术后左心室射血分数（LVEF）显著更高（0.59 ± 0.09 比 0.55 ± 0.11， = 0.006），体外循环（CPB）时间更长（128 比 111 分钟， = 0.002）。45 例（14.7%）患者发生早期不良事件，单纯 AVR 组更常见（22.1%比 11.8%， = 0.020）。符合 45mm 标准可预测早期不良事件发生率较低（风险比[HR]：0.53，95%置信区间[CI]：0.28-0.98， = 0.042）。在校正性别、年龄、升主动脉直径、窦部直径、术前 LVEF、Sievers 亚型、BAV 瓣叶病变、CPB 和体外循环夹闭时间后，符合 45mm 尺寸标准仍可预测早期不良事件发生率较低（HR：0.37，95%CI：0.15-0.90， = 0.028）。
本研究表明，对于行 BAV 主动脉瓣置换术的患者，预先进行 45mm 升主动脉置换术符合尺寸标准不会增加不良事件风险，可能改善早期手术结局。
