再次主动脉根部手术的结果。

Outcomes of reoperative aortic root surgery.

作者信息

Brown James A, Serna-Gallegos Derek, Kilic Arman, Longo Sadie, Chu Danny, Navid Forozan, Dunn-Lewis Courtenay, Sultan Ibrahim

机构信息

Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.

Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.

出版信息

J Thorac Cardiovasc Surg. 2023 Sep;166(3):716-724.e3. doi: 10.1016/j.jtcvs.2021.09.060. Epub 2021 Oct 23.

DOI:10.1016/j.jtcvs.2021.09.060

PMID:34776246

Abstract

OBJECTIVE

The study objective was to determine the impact of reoperative aortic root replacement on short-term outcomes and survival.

METHODS

This was a retrospective study of aortic root operations from 2010 to 2018. All patients with a complete aortic root replacement were included, and patients undergoing valve-sparing root replacements were excluded. Patients were dichotomized by first-time sternotomy versus redo sternotomy, which was defined as having had a prior sternotomy for whatever reason. Within the redo sternotomy group, reoperative aortic root replacements were identified, being defined as a complete aortic root replacement in patients with a prior aortic root replacement; 1:1 nearest neighbor propensity matching was used to compare outcomes across groups. Kaplan-Meier survival estimates were generated and compared using log-rank statistics.

RESULTS

A total of 893 patients undergoing complete ARR were identified, of whom 595 (67%) underwent first-time sternotomy and 298 (33%) underwent redo sternotomy. After matching, postoperative outcomes were similar for the first-time and redo sternotomy groups, including operative mortality. Redo sternotomy was not associated with reduced survival after aortic root replacement compared with first-time sternotomy (P = .084), with 5-year survival of 73.7% for first-time sternotomy and 72.9% for redo sternotomy. In the redo sternotomy group (n = 298), 69 (23%) were reoperative aortic root replacements and 229 (77%) were first-time aortic root replacements. After matching, postoperative outcomes were similar for the first-time and reoperative aortic root replacement groups, including operative mortality. Reoperative aortic root replacement was not associated with reduced survival, compared with first-time aortic root replacement (P = .870), with 5-year survival of 67.9% for first-time aortic root replacement and 72.1% for reoperative aortic root replacement.

CONCLUSIONS

Reoperative aortic root replacement can be performed safely and provides similar survival to first-time aortic root replacement.

摘要

目的

本研究的目的是确定再次主动脉根部置换对短期结局和生存率的影响。

方法

这是一项对2010年至2018年主动脉根部手术的回顾性研究。纳入所有接受完整主动脉根部置换的患者，排除接受保留瓣膜根部置换的患者。患者按首次胸骨切开术与再次胸骨切开术分为两组，再次胸骨切开术定义为因任何原因曾接受过胸骨切开术。在再次胸骨切开术组中，确定再次主动脉根部置换，定义为既往接受过主动脉根部置换的患者进行完整的主动脉根部置换；采用1:1最近邻倾向匹配法比较各组间的结局。生成Kaplan-Meier生存估计值，并使用对数秩统计进行比较。

结果

共确定893例接受完整主动脉根部置换的患者，其中595例（67%）接受首次胸骨切开术，298例（33%）接受再次胸骨切开术。匹配后，首次和再次胸骨切开术组的术后结局相似，包括手术死亡率。与首次胸骨切开术相比，再次胸骨切开术与主动脉根部置换术后生存率降低无关（P = 0.084），首次胸骨切开术的5年生存率为73.7%，再次胸骨切开术为72.9%。在再次胸骨切开术组（n = 298）中，69例（23%）为再次主动脉根部置换，229例（77%）为首次主动脉根部置换。匹配后，首次和再次主动脉根部置换组的术后结局相似，包括手术死亡率。与首次主动脉根部置换相比，再次主动脉根部置换与生存率降低无关（P = 0.870），首次主动脉根部置换的5年生存率为67.9%，再次主动脉根部置换为72.1%。