Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
J Card Surg. 2021 Jun;36(6):1953-1957. doi: 10.1111/jocs.15465. Epub 2021 Mar 2.
Bicuspid aortic valve (BAV) is the most common congenital heart defect and it is responsible for an increased risk of developing aortic valve and ascending aorta complications. In case of mild to moderate BAV disease in patients undergoing supracoronary ascending aorta replacement, it is unclear whether a concomitant aortic valve replacement should be performed.
From June 2002 to January 2020, 75 patients with mild-to-moderate BAV regurgitation (±mild-to-moderate stenosis) who underwent isolated supracoronary ascending aorta replacement were retrospectively analyzed. Clinical and echocardiographic follow-up was 100% complete (mean: 7.4 ± 3.9 years, max: 16.4). Kaplan-Meier estimates were employed to analyze long-term survival. Cumulative incidence function (CIF) for time to reoperation, recurrence of aortic regurgitation (AR) ≥3+ and aortic stenosis (AS) greater than moderate, with death as competing risk, were computed.
There was no hospital mortality and no cardiac death occurred. Overall survival at 12 years was 97.4 ± 2.5%, 95% confidence interval (CI: 83.16-99.63). At follow-up there were no cases of aortic root surgery whereas three patients underwent AV replacement. At 12 years the CIF of reoperation was 2.6 ± 2.5%, 95% CI [0.20-11.53]. At follow-up, AR 3+/4+ was present in 1 pt and AS greater than moderate in 3. At 12 years the CIF of AR more than 2+/4+ was 5.1 ± 4.98% and of AS more than moderate 6.9 ± 3.8%.
In our study mild to moderate regurgitation of a BAV did not do significantly worse at least up to 10 years after isolated supracoronary ascending aorta replacement.
二叶式主动脉瓣（BAV）是最常见的先天性心脏缺陷，它会增加发生主动脉瓣和升主动脉并发症的风险。在接受冠状动脉以上升主动脉置换术的患者中，如果存在轻度至中度 BAV 疾病，尚不清楚是否应同时进行主动脉瓣置换术。
从 2002 年 6 月至 2020 年 1 月，回顾性分析了 75 例接受单纯冠状动脉以上升主动脉置换术的轻度至中度 BAV 反流（±轻度至中度狭窄）患者。临床和超声心动图随访率为 100%（平均：7.4±3.9 年，最长：16.4 年）。采用 Kaplan-Meier 估计法分析长期生存率。计算主动脉瓣反流（AR）≥3+和主动脉瓣狭窄（AS）大于中度的再手术、AR 复发和 AS 复发的时间的累积发生率（CIF），以死亡为竞争风险。
无院内死亡，无心脏死亡。12 年总生存率为 97.4±2.5%，95%置信区间（CI：83.16-99.63）。随访期间无主动脉根部手术，3 例患者行 AV 置换术。12 年时，再手术的 CIF 为 2.6±2.5%，95%CI [0.20-11.53]。随访时，1 例患者存在 3+/4+AR，3 例患者存在 AS 大于中度。12 年时，AR 大于 2+/4+的 CIF 为 5.1±4.98%，AS 大于中度的 CIF 为 6.9±3.8%。
在我们的研究中，至少在冠状动脉以上升主动脉置换术 10 年后，轻度至中度 BAV 反流的患者情况并未明显恶化。
