Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
Scand Cardiovasc J. 2021 Jun;55(3):173-179. doi: 10.1080/14017431.2020.1869298. Epub 2021 Jan 27.
We report the mid-term outcomes of valve-sparing aortic root replacement (VSRR) in a cohort including patients with bicuspid aortic valve (BAV), connective tissue disorder (CTD), aortic dissection (AD), and congenital heart disease (CHD). . From 2005 to 2017, 174 patients underwent VSRR with the reimplantation technique. The mean age was 46 ± 14 years. The mean follow-up time was 4.8 ± 2.8 years. The indication for operation was aortic aneurysm for 127 (73%), aortic insufficiency (AI) for 38 (22%), and AD for 9 patients (5%). Preoperatively, 53 patients (31%) had ≥ moderate AI. BAV, CTD (Marfan or Loyes-Dietz), previous Ross procedure, or CHD was present in 57 (33%), 28 (16%), 7 (4%) and 12 patients (7%), respectively. Concomitant aortic valve repair was performed for 103 patients (59%). . Thirty-day mortality was zero. Four patients underwent aortic valve replacement (AVR) during follow-up. Kaplan-Meier estimates for survival, freedom from AVR, and freedom from ≥ moderate AI or reoperation were 96, 98, and 97% at 5 years. There was no difference in survival, freedom from AVR, or freedom from ≥ moderate AI or reoperation in patients with and without BAV, CTD, leaflet repair, or preoperative ≥ moderate AI. In Cox regression analysis, BAV, CTD, aortic valve repair, preoperative ≥ moderate AI, or aortic dimension were not risk factors for reoperation or valve dysfunction. . Mid-term outcomes of VSRR for patients with diverse indications in terms of survival, reoperation rate, and valve dysfunction rate were excellent in a center with a limited annual volume of VSSR.
我们报告了包括二叶式主动脉瓣（BAV）、结缔组织疾病（CTD）、主动脉夹层（AD）和先天性心脏病（CHD）患者在内的一组患者行保留瓣膜主动脉根部替换术（VSRR）的中期结果。2005 年至 2017 年，174 例行 VSRR 手术，采用再植入技术。平均年龄为 46±14 岁。平均随访时间为 4.8±2.8 年。手术指征为主动脉瘤 127 例（73%），主动脉瓣关闭不全（AI）38 例（22%），AD 9 例（5%）。术前，53 例（31%）有≥中度 AI。57 例（33%）、28 例（16%）、7 例（4%）和 12 例（7%）分别存在 BAV、CTD（马凡或洛伊茨-迪茨）、既往罗斯手术或 CHD。103 例行主动脉瓣修复术（59%）。30 天死亡率为 0。随访期间有 4 例患者行主动脉瓣置换术（AVR）。5 年时，生存率、免于 AVR、免于≥中度 AI 或再次手术的 Kaplan-Meier 估计分别为 96%、98%和 97%。在有无 BAV、CTD、瓣叶修复、术前≥中度 AI 的患者中，生存率、免于 AVR、免于≥中度 AI 或再次手术无差异。在 Cox 回归分析中，BAV、CTD、主动脉瓣修复、术前≥中度 AI 或主动脉尺寸不是再次手术或瓣膜功能障碍的危险因素。在一个 VSRR 年手术量有限的中心，VSRR 治疗各种适应证的患者中期生存、再次手术率和瓣膜功能障碍率结果优异。
