Department of Cardiothoracic Surgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York City, New York, USA.
J Card Surg. 2022 Aug;37(8):2326-2335. doi: 10.1111/jocs.16597. Epub 2022 May 9.
The American Association of Thoracic Surgery published guidelines in 2018 encouraging regular surveillance rather than surgical intervention for ascending aortic aneurysms under 5.5 cm in both bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients. Since then, there have been limited studies reporting outcomes, especially by valve type. We aimed to analyze clinical outcomes including survival and aortic events in a cohort of BAV and TAV patients with ascending aortic aneurisms followed conservatively with routine computerized tomography (CT) surveillance per current guidelines.
We followed 188 patients in our clinic between 2016 and 2019; 147 had two or more CT scans which allowed measurement of aortic growth. Echocardiogram data was evaluated for each patient. We identified similar cohorts of BAV (n = 32) and TAV (n = 64) patients matched by age, sex, hypertension, smoking history, family history of aortic disease, coronary artery disease, and hyperlipidemia. Univariate and multivariate analyses of the unmatched cohorts were performed.
The mean aneurysm size was 4.3 ± 0.58 cm with 95% confidence interval (3.14, 5.46). This did not differ between BAV and TAV patients, nor did aneurysm growth rates. Overall adverse event rate (dissection, rupture, and death) was low for the entire cohort (BAV group, 3% and TAV group, 3.5%). Survival at 10 years for the entire cohort was 90 ± 32%.
Regardless of aortic valve type, there was a similar natural history and low adverse event rate. In the absence of risk factors, conservative management can be accomplished with minimal risk to the patient.
美国胸外科学会于 2018 年发布指南，鼓励对二叶式主动脉瓣（BAV）和三叶式主动脉瓣（TAV）患者升主动脉瘤直径小于 5.5cm 的患者进行常规监测而非手术干预。此后，仅有有限的研究报告了相关结果，特别是关于瓣膜类型。我们旨在分析按照现行指南通过常规计算机断层扫描（CT）监测进行保守治疗的 BAV 和 TAV 患者伴发升主动脉瘤的临床结局，包括生存率和主动脉相关事件。
我们对 2016 年至 2019 年期间在我院就诊的 188 例患者进行了随访；其中 147 例患者进行了两次或更多次 CT 扫描，以便测量主动脉瘤的生长情况。对每位患者的超声心动图数据进行了评估。我们根据年龄、性别、高血压、吸烟史、主动脉疾病家族史、冠心病和高脂血症，分别为 BAV（n=32）和 TAV（n=64）患者匹配了相似的队列。对未匹配的队列进行了单变量和多变量分析。
平均动脉瘤直径为 4.3±0.58cm，95%置信区间（3.14，5.46）。BAV 和 TAV 患者之间的动脉瘤大小无差异，且动脉瘤生长速度也无差异。整个队列的总体不良事件发生率（夹层、破裂和死亡）较低（BAV 组为 3%，TAV 组为 3.5%）。整个队列的 10 年生存率为 90±32%。
无论主动脉瓣类型如何，其自然病史相似，不良事件发生率较低。在无危险因素的情况下，通过保守治疗可以使患者面临的风险最小化。
