Department of Cardiac Surgery, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan.
Heart Vessels. 2022 Aug;37(8):1462-1469. doi: 10.1007/s00380-022-02028-9. Epub 2022 Feb 5.
Root infection or dissection involving coronary artery frequently necessitates an emergent Bentall procedure, with low left ventricular ejection fraction (LVEF). In contrast, concerning an elective Bentall for aneurysm, surgeons should balance the risk and benefit of surgery, especially in low LVEF cases. We investigated the association between preoperative LVEF and outcomes after Bentall. We analyzed 98 patients undergoing Bentall between April 2000 and March 2020. The patients were stratified into three groups: (a) 65 with LVEF ≥ 60%, (b) 21 with LVEF 45 to < 60%, and (c) 12 with LVEF < 45%. Baseline characteristics, survivals, and major adverse cardiovascular events (MACE) were compared. To assess potential non-linear relationship between LVEF and mortality, cubic spline analysis was conducted. Median age was similar (a vs b vs c, 52 vs 50 vs 44). In all groups, elective root aneurysm was 50-60%, indicating the rest were complicated and sick. Operative mortality was the highest in group c (4.6% vs 9.5% vs 16.7%, p = 0.294). Survival and MACE-free rate were the worst in group c, though their 10-year survival was 40%. LVEF was an independent risk for mortality, and cubic spline analysis showed potential non-linear association between LVEF and mortality. Although LVEF is an independent predictor of mortality after Bentall, long-term survival was occasionally achieved in low LVEF cases. While surgeons should carefully balance the risk of low LVEF and the benefit of surgery in elective cases, we should perform a non-elective procedure as needed, even if LVEF is low.
根部感染或涉及冠状动脉的夹层常需要紧急 Bentall 手术，此时左心室射血分数（LVEF）较低。相比之下，对于择期 Bentall 手术治疗动脉瘤，外科医生应权衡手术的风险和获益，尤其是在 LVEF 较低的情况下。我们研究了术前 LVEF 与 Bentall 术后结果之间的关系。我们分析了 2000 年 4 月至 2020 年 3 月期间接受 Bentall 手术的 98 例患者。患者分为三组：（a）LVEF≥60%的 65 例，（b）LVEF 为 45%至<60%的 21 例，（c）LVEF<45%的 12 例。比较了各组的基线特征、存活率和主要不良心血管事件（MACE）。为评估 LVEF 与死亡率之间的潜在非线性关系，进行了三次样条分析。各组的中位年龄相似（a 组 vs b 组 vs c 组，52 岁 vs 50 岁 vs 44 岁）。在所有组中，择期根部动脉瘤的比例为 50%至 60%，提示其余患者病情复杂且严重。c 组的手术死亡率最高（4.6% vs 9.5% vs 16.7%，p=0.294）。c 组的生存和无 MACE 率最差，尽管其 10 年生存率为 40%。LVEF 是死亡率的独立危险因素，三次样条分析显示 LVEF 与死亡率之间存在潜在的非线性关系。虽然 LVEF 是 Bentall 术后死亡率的独立预测因素，但在 LVEF 较低的情况下，偶尔也能实现长期生存。虽然外科医生应在择期病例中仔细权衡低 LVEF 的风险和手术的获益，但我们应根据需要进行非择期手术，即使 LVEF 较低。
