Nguyen Stephanie N, Yamabe Tsuyoshi, Zhao Yanling, Kurlansky Paul A, George Isaac, Smith Craig R, Takayama Hiroo
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York.
Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Medical Center, New York, New York; Department of Cardiac Surgery, Shonan Kamakura General Hospital, Kamakura, Japan.
Semin Thorac Cardiovasc Surg. 2021 Winter;33(4):933-943. doi: 10.1053/j.semtcvs.2021.02.004. Epub 2021 Feb 17.
David V valve-sparing root replacement (VSRR) and bio-Bentall (BB) are increasingly performed for aortic root aneurysms associated with a bicuspid aortic valve (BAV). However, durability remains a concern in both procedures. We compared the 10-year outcomes of VSRR vs BB for BAV-associated root aneurysms. A retrospective review identified 134 patients with a BAV-associated root aneurysm who underwent VSRR (n = 65) or BB (n = 69) from 2005 to 2019. Patients with aortic stenosis, endocarditis, previous aortic valve replacement, and emergent cases were excluded. Propensity-score matching was performed, resulting in 2 risk-adjusted groups (n = 40 per group). Median follow-up was 6.21 (1.43-8.28) years. The VSRR cohort was younger (46.0 years vs 56.0 years, P < 0.001) and had a lower incidence of at least moderate aortic insufficiency (AI) (78.5% vs 92.8%, P = 0.02). The incidence of Marfan syndrome, aortic root diameter, and ascending aortic diameter were similar. In-hospital mortality was 1.5% (n = 1) and 1.4% (n = 1) for VSRR and BB, respectively. There was no difference between VSRR and BB in 10-year survival (98.3% [95% confidence interval (CI): 88.6-99.8%] vs 96.2% [95% CI: 85.5-99.0%], P = 0.567) and aortic valve reintervention at 10 years (16.1% [95% CI: 6.3-29.8%] vs 12.9% [95% CI: 3.7-28.0%], P = 0.309). The most common reason for valve reintervention in both groups was AI. Survival and valve reintervention at 10 years were similar in the matched cohort. David V VSRR yields similar mid to long-term outcomes to BB for select patients with a BAV-associated aortic root aneurysm in regards to survival and reintervention rates. Further studies comparing longer term outcomes between root replacement techniques and native valve durability are needed.
大卫V型保留瓣膜根部置换术（VSRR）和生物带瓣管道（BB）越来越多地用于治疗与二叶式主动脉瓣（BAV）相关的主动脉根部瘤。然而，这两种手术的耐久性仍然是一个问题。我们比较了VSRR与BB治疗BAV相关根部瘤的10年结果。一项回顾性研究确定了134例2005年至2019年期间接受VSRR（n = 65）或BB（n = 69）治疗的BAV相关根部瘤患者。排除患有主动脉瓣狭窄、心内膜炎、既往主动脉瓣置换术的患者以及急诊病例。进行倾向评分匹配，形成2个风险调整组（每组n = 40）。中位随访时间为6.21（1.43 - 8.28）年。VSRR组患者更年轻（46.0岁对56.0岁，P < 0.001），至少中度主动脉瓣关闭不全（AI）的发生率更低（78.5%对92.8%，P = 0.02）。马凡综合征的发生率、主动脉根部直径和升主动脉直径相似。VSRR组和BB组的住院死亡率分别为1.5%（n = 1）和1.4%（n = 1）。VSRR和BB在10年生存率（98.3% [95%置信区间（CI）：88.6 - 99.8%]对96.2% [95% CI：85.5 - 99.0%]，P = 0.567）和10年时主动脉瓣再次干预率（16.1% [95% CI：6.3 - 29.8%]对12.9% [95% CI：3.7 - 28.0%]，P = 0.309）方面没有差异。两组瓣膜再次干预最常见的原因是AI。在匹配队列中，10年时的生存率和瓣膜再次干预情况相似。对于特定的BAV相关主动脉根部瘤患者，就生存率和再次干预率而言，大卫V型VSRR产生的中长期结果与BB相似。需要进一步研究比较根部置换技术之间的长期结果以及自体瓣膜的耐久性。
