Department of Surgery, Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA.
Department of Medicine, Division of Cardiology, Feinberg School of Medicine and Northwestern Medicine, Northwestern University, Chicago, Illinois, USA.
J Card Surg. 2022 Jul;37(7):1947-1956. doi: 10.1111/jocs.16473. Epub 2022 Apr 5.
Valve-sparing aortic root replacement (VSARR) is an alternative to valve-replacing aortic root replacement (VRARR) with valved-conduits based on recent guidelines for clinical practice. This study investigated outcomes of these two procedures in patients with nonstenotic valves.
Between January 7, 2007 and June 30, 2019, 475 patients with aortic root aneurysm without aortic stenosis underwent VSARR (151) or VRARR (324) techniques. Propensity score-matching (PSM) was used to alleviate confounding. Endpoints were 30-day mortality, 8-year survival and reoperation, aortic regurgitation, and valve gradients.
PSM created 69 pairs of patients with a mean age 52 ± 13 years (10.1% Marfan syndrome, 34.8% bicuspid aortic valve). There was no statistically significant difference in major perioperative morbidity or 30-day mortality (0% VSARR vs. 1.4% VRARR; p = 0.316). Overall survival was significantly higher (p = 0.025) in the VSARR group versus the VRARR group (8-year estimates 100% vs. 88.9%, respectively), while freedom from valve reoperation was similar (p = 0.97, 8-year estimates 90.9% vs. 96.7%, respectively). Freedom from > moderate-severe AR was not significantly different (p = 0.08, 8-year estimates 90.0% VSARR group vs. 100% VRARR), but mean valve gradients at last follow-up were better in the VSARR group (5.9 vs. 13.2 mmHg, p < 0.001).
VSARR is a safe operation in patients with aortic root aneurysm and nonstenotic aortic valves in the hands of experienced surgeons. Freedom from reoperation is similar and the mode of aortic valve failure differs between the two groups.
基于最近的临床实践指南，保留瓣膜的主动脉根部替换术（VSARR）是替换瓣膜的主动脉根部替换术（VRARR）的替代方法，该方法使用带瓣管道。本研究调查了这两种手术在非狭窄瓣膜患者中的结果。
2007 年 1 月 7 日至 2019 年 6 月 30 日，475 例主动脉根部瘤无主动脉瓣狭窄患者接受 VSARR（151 例）或 VRARR（324 例）治疗。采用倾向评分匹配（PSM）减轻混杂因素。终点为 30 天死亡率、8 年生存率和再手术、主动脉瓣反流和瓣膜梯度。
PSM 产生了 69 对平均年龄 52±13 岁的患者（10.1%马凡综合征，34.8%二叶式主动脉瓣）。主要围手术期发病率或 30 天死亡率无统计学差异（0% VSARR 与 1.4% VRARR；p=0.316）。VSARR 组的总体生存率明显高于 VRARR 组（8 年估计值分别为 100%和 88.9%，p=0.025），而瓣膜再手术的无失败率相似（p=0.97，8 年估计值分别为 90.9%和 96.7%）。无>中度严重 AR 无显著差异（p=0.08，8 年估计值分别为 90.0% VSARR 组和 100% VRARR 组），但 VSARR 组的平均瓣膜梯度在最后一次随访时更好（5.9 与 13.2mmHg，p<0.001）。
在经验丰富的外科医生手中，VSARR 是治疗主动脉根部瘤和非狭窄主动脉瓣患者的一种安全手术。再手术的无失败率相似，两组主动脉瓣失败模式不同。
