Division of Cardiothoracic Surgery, GangNeung Asan Hospital, Gangwon-do, Korea.
Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Interact Cardiovasc Thorac Surg. 2022 Jun 1;34(6):1106-1112. doi: 10.1093/icvts/ivac073.
This study investigated the effect of a bicuspid pulmonary valve on neoaortic root morphology, function, and the clinical outcomes of early survivors after the arterial switch operation using propensity score matching.
From 1997 to 2018, a total of 442 patients underwent the arterial switch operation for transposition of the great arteries. After exclusion of patients who underwent a staged repair, were repaired beyond 1 year of age, died before discharge and who lacked echocardiographic data at discharge, propensity score matching was used for analysis.
Among 352 eligible patients, 18 patients (5.1%) had a bicuspid pulmonary valve. After propensity score matching (1:4), 15 patients with bicuspid valve (bicuspid group) and 60 patients with tricuspid valve (tricuspid group) were enrolled. The median follow-up duration was 9.9 years (4 months∼22.3 years). All-cause reoperation-free survival at 10 years was 93.3% in the bicuspid group and 87.0% in the tricuspid group (P = 0.839), and reoperation for neoaortic valve or root was required in 2 patients in the bicuspid group and 1 in the tricuspid group without intergroup difference. The z-score of the neoaortic annulus did not change in either group, although there was an increasing tendency in the z-score of the neoaortic sinus without intergroup difference (P = 0.690). Deterioration in neoaortic valve function was more prominent in the bicuspid group (p = 0.028).
The neoaortic sinus might outgrow the norm regardless of the number of neoaortic valve cusps, whereas the neoaortic annulus remained unchanged. Deterioration of valve function was more prominent in the bicuspid group, which suggests that a bicuspid valve might play a significant role in deterioration of neoaortic valve function, without an additional effect on root pathology.
本研究通过倾向评分匹配，探讨二叶式肺动脉瓣对大动脉转位患者动脉调转术后新主动脉根部形态、功能和早期生存者临床结局的影响。
1997 年至 2018 年，共有 442 例患者接受大动脉调转术治疗大动脉转位。排除分期修复、修复年龄超过 1 岁、出院前死亡以及出院时缺乏超声心动图数据的患者后，采用倾向评分匹配进行分析。
在 352 例符合条件的患者中，18 例（5.1%）有二叶式肺动脉瓣。经倾向评分匹配（1:4）后，纳入 15 例二叶瓣患者（二叶瓣组）和 60 例三叶瓣患者（三叶瓣组）。中位随访时间为 9.9 年（4 个月~22.3 年）。二叶瓣组和三叶瓣组患者 10 年全因无再次手术生存率分别为 93.3%和 87.0%（P=0.839），二叶瓣组和三叶瓣组分别有 2 例和 1 例患者因新发主动脉瓣或根部需要再次手术，两组间无差异。两组新主动脉瓣环 z 值均无变化，尽管新主动脉窦 z 值呈上升趋势，但两组间无差异（P=0.690）。二叶瓣组新发主动脉瓣功能恶化更为明显（p=0.028）。
无论新主动脉瓣叶数量如何，新主动脉窦可能会超出正常范围，而新主动脉瓣环保持不变。二叶瓣组瓣叶功能恶化更为明显，这表明二叶瓣可能在新发主动脉瓣功能恶化中起重要作用，而对根部病变无额外影响。
