采用主动脉根部游离移植物行主动脉置换及开放式吻合术：回顾性分析。
Freestyle aortic root prosthesis in combination with aortic replacement and open anastomosis: a retrospective analysis.
机构信息
Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, Sydney Street, London, SW3 6NP, UK.
University of Zurich, Rämistrasse 71, 8001, Zurich, Switzerland.
出版信息
J Cardiothorac Surg. 2021 Jun 26;16(1):185. doi: 10.1186/s13019-021-01562-3.
BACKGROUND
The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardised technique of unilateral antegrade cerebral perfusion under moderate hypothermia.
METHODS
Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (open arch anastomosis (OA) versus non-open arch anastomosis (non-OA) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival.
RESULTS
The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p < 0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p = 0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p = 0.001) and shorter hospital stay (9 vs 12 days, p = 0.0004). There were no differences in the mortality (in-hospital: OA 8 (7%) vs non-OA 8 (5%); p = 0.6; death at follow-up: OA 5 (5%) vs non-OA 15 (11%); p = 0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up.
CONCLUSION
The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.
背景
Freestyle®生物假体用于主动脉根部病变。在夹层或动脉瘤中，可能需要额外切除升主动脉和近端弓。目的是评估中期结果，包括假体性能、中风、再次手术和存活率，比较有和无升主动脉和近端弓附加手术的患者，重点关注中度低温下单侧顺行脑灌注的标准化技术。
方法
回顾性分析 2007 年 9 月至 2017 年 3 月期间 278 例连续行 Freestyle®根部置换术患者的数据。根据主动脉根部病变（再次手术 vs 心内膜炎 vs 夹层）将患者分为三组。根据主动脉吻合技术将两组（开放弓吻合（OA）与非开放弓吻合（非-OA））进行比较（119 例 OA 与 159 例非-OA）。评估心血管风险、既往心脏事件、围术期数据。采用 Mann-Whitney U 检验进行推断统计学分析。名义和分类变量采用 Fisher-Freeman-Halton 确切检验进行检验。Kaplan-Meier 估计用于评估存活率。
结果
随访率为 90%（中位随访时间：39.5 个月）。适应证存在差异（心内膜炎：OA 5 例（4.2%）与非-OA 36 例（24%），p<0.0001；夹层：OA 13 例（10.9%）与非-OA 2 例（1.3%）；p=0.0007）。OA 患者围手术期中风发生率较低（1 例（1%）与 15 例（10%），p=0.001），住院时间较短（9 天与 12 天，p=0.0004）。死亡率无差异（院内：OA 8 例（7%）与非-OA 8 例（5%），p=0.6；随访期间死亡：OA 5 例（5%）与非-OA 15 例（11%），p=0.1）。整体瓣膜功能在随访时显示 97.3%的瓣膜功能良好。
结论
无论初始适应证如何，瓣膜功能均显示出良好的结果。接受单侧顺行脑灌注开放弓吻合术的患者中风发生率较低，死亡率或住院时间无延长。
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