Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland.
Thorac Cardiovasc Surg. 2022 Jun;70(4):297-305. doi: 10.1055/s-0041-1723844. Epub 2021 Feb 18.
Most data after root replacement with reimplantation of the aortic valve originate from high-volume centers. This raises concerns about the generalizability of these data and the reproducibility of this complex procedure. Aim of this study is to assess the perioperative and midterm outcomes of this procedure in a low-volume center.
We performed a retrospective analysis of the data of 72 patients, who underwent root replacement with reimplantation of the aortic valve in a single center between 2011 and 2020. Time to event analysis was performed with Kaplan-Meier curves. Longitudinal analysis of serial echocardiographic data was performed with a mixed-effects ordinal logistic regression model.
In-hospital mortality was 1.4%, with absence of any neurological events during the perioperative period. At midterm follow-up, two further patients died. Overall survival rates at 1 and 5 years were 98.5% (95% confidence interval [CI]: 97-100%) and 96.3% (95% CI: 93.8-98.8%), respectively. During follow-up, five patients (6.9%) required reoperation on the aortic valve. The incidence of moderate and severe aortic regurgitation at 5 years was 6.6% (95% CI: 2.4-13.6%) and 0.6% (95% CI: 0.1-3.2%), respectively. Mild aortic regurgitation at hospital discharge ( < 0.001) and cusp plication ( = 0.0121) were associated with a higher incidence of moderate or severe aortic regurgitation at follow-up.
Reimplantation of the aortic valve is safe and feasible even in a low-volume center. Mortality, freedom from reoperation, and incidence of moderate or severe aortic regurgitation at follow-up are comparable to those of high-volume centers.
大多数主动脉瓣根部替换后再植入的资料来源于高容量中心。这引起了对这些数据的普遍性和这种复杂手术的可重复性的关注。本研究的目的是在低容量中心评估该手术的围手术期和中期结果。
我们对 2011 年至 2020 年间在一家中心接受主动脉瓣根部替换后再植入的 72 例患者的数据进行了回顾性分析。使用 Kaplan-Meier 曲线进行事件时间分析。使用混合效应有序逻辑回归模型对连续超声心动图数据进行纵向分析。
院内死亡率为 1.4%，围手术期无任何神经事件。在中期随访中，另外两名患者死亡。1 年和 5 年的总生存率分别为 98.5%（95%置信区间：97-100%）和 96.3%（95%置信区间：93.8-98.8%）。随访期间，5 例患者（6.9%）需要再次行主动脉瓣手术。5 年时中度和重度主动脉瓣反流的发生率分别为 6.6%（95%置信区间：2.4-13.6%）和 0.6%（95%置信区间：0.1-3.2%）。出院时轻度主动脉瓣反流（ < 0.001）和瓣叶缝合（ = 0.0121）与随访时中度或重度主动脉瓣反流的发生率较高相关。
即使在低容量中心，主动脉瓣根部替换后再植入也是安全可行的。死亡率、免于再次手术和随访时中度或重度主动脉瓣反流的发生率与高容量中心相当。
