Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Ann Thorac Surg. 2022 Jan;113(1):25-32. doi: 10.1016/j.athoracsur.2021.03.004. Epub 2021 Mar 8.
This study aims to comprehensively characterize details of aortic and aortic valve reinterventions after aortic root replacement (ARR).
Between 2005 and 2019, 882 patients underwent ARR. Indications were aneurysm in 666, aortic valve related in 116, aortic dissection in 64, and infective endocarditis (IE) in 36. Valve-sparing root replacement was performed in 290 patients, whereas a Bio-Bentall procedure was done in 528. Among them, 52 patients (5.9%) required reintervention. The incidence, cause, and time to reintervention and the outcomes after reintervention were investigated. A cause-specific Cox hazard model was performed to identify predictors for reintervention after ARR.
The 10-year cumulative incidence of aortic and aortic valve reintervention after ARR was 10.3% (95% confidence interval, 7.3%-14.0%). Age per year decrease was the only independent predictor for reintervention (subdistribution hazard ratio, 0.97; 95% confidence interval, 0.95-0.99). The causes for 52 reinterventions were aortic valve causes in 29 patients (55.8%), including aortic stenosis/insufficiency, and prosthetic valve dysfunction; IE in 15 (28.9%); aortic-related causes in 7 (13.5%), including pseudoaneurysm, development of aneurysm, and residual dissection; and coronary button pseudoaneurysm in 1 (1.9%). Median time to reintervention was 11.0 months (interquartile range, 2.0-20.5) for IE, 24.0 months (interquartile range, 3.7-46.1) for aortic-related causes, and 77.0 months (interquartile range, 28.4-97.6) for aortic valve-related causes (P = .005). Overall in-hospital mortality after the reinterventions was 7.7% (4/52) with 20.0% for IE (3/15).
Reintervention for IE occurred relatively early after ARR, whereas aortic valve- and aortic-related reinterventions gradually increased over time. In-hospital mortality after the reintervention was low, with the exception of IE.
本研究旨在全面描述主动脉根部置换（ARR）后主动脉和主动脉瓣再次介入的细节。
2005 年至 2019 年间，882 例患者接受了 ARR。适应证为 666 例动脉瘤，116 例主动脉瓣相关疾病，64 例主动脉夹层，36 例感染性心内膜炎（IE）。290 例患者行保留主动脉瓣根部置换术，528 例行生物 Bentall 手术。其中，52 例（5.9%）需要再次介入治疗。研究了再次介入的发生率、原因、时间以及再次介入后的结局。采用特定于原因的 Cox 风险模型确定 ARR 后再次介入的预测因素。
ARR 后 10 年主动脉和主动脉瓣再次介入的累积发生率为 10.3%（95%置信区间，7.3%-14.0%）。年龄每年减少是再次介入的唯一独立预测因素（亚分布风险比，0.97；95%置信区间，0.95-0.99）。52 例再次介入的原因包括 29 例主动脉瓣原因（55.8%），包括主动脉瓣狭窄/关闭不全和人工瓣膜功能障碍；IE 为 15 例（28.9%）；主动脉相关原因 7 例（13.5%），包括假性动脉瘤、动脉瘤形成和残余夹层；1 例（1.9%）为冠状动脉纽扣假性动脉瘤。IE 的再次介入中位时间为 11.0 个月（四分位距，2.0-20.5），主动脉相关原因的再次介入中位时间为 24.0 个月（四分位距，3.7-46.1），主动脉瓣相关原因的再次介入中位时间为 77.0 个月（四分位距，28.4-97.6）（P=0.005）。再次介入后的院内总死亡率为 7.7%（4/52），IE 为 20.0%（3/15）。
ARR 后 IE 的再次介入相对较早发生，而主动脉瓣和主动脉相关的再次介入随着时间的推移逐渐增加。再次介入后的院内死亡率较低，IE 除外。
