Corona Silvia, Manganiello Sabrina, Pepi Mauro, Tamborini Gloria, Muratori Manuela, Ali Sarah Ghulam, Capra Nicolò, Naliato Moreno, Alamanni Francesco, Zanobini Marco
Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Ann Med Surg (Lond). 2022 Apr 12;77:103624. doi: 10.1016/j.amsu.2022.103624. eCollection 2022 May.
Structural valve deterioration (SVD) remains the major determinant of bioprosthesis durability. The aim of this study was to investigate the SVD incidence, predictors and outcomes in patients aged 50 years and younger after bioprosthetic aortic valve replacement (bAVR).
We retrospectively analyzed 73 consecutive patients ≤50 years old who underwent bioprosthetic AVR at our center between 2005 and 2015. Median age at surgery was 44 (interquartile range [IQR]: 39-47) years. Follow-up was 93.2% complete at a median time of 7.2 (IQR: 5.5-9.5) years. Cumulative follow-up was 545.5 valve-years. Bioprosthesis SVD was determined by strict echocardiographic assessment.
The overall survival-rate at 10/15 years and freedom from SVD at 10/12.5 years were 89.6 ± 5.2%/81.5 ± 9.1% and 73.5 ± 8.2%/41.9 ± 18.9%, respectively. SVD occurred at a median time of 8.2 (IQR: 6.0-9.9) years after bAVR. Age was not found as an independent predictor for SVD at the multivariable model, despite a higher rate of SVD in the age group ≤30 years. Freedom from reoperation due to SVD at 10/15 years was 71.3 ± 14.1%/13.6 ± 12.3%. Reoperation was performed at a median time of 10.0 (IQR: 8.9-11.9) years since first bAVR and was associated with a 100% 12-month survival.
In our study, the rate and time of SVD occurrence were comparable to those of other studies' older age groups. Strict echocardiographic monitoring of valve performance is mandatory to set the appropriate timing of eventual reoperation. This attitude can improve outcomes of bAVR in younger patients.
结构瓣膜退变（SVD）仍然是生物瓣膜耐久性的主要决定因素。本研究的目的是调查50岁及以下患者生物人工主动脉瓣置换术（bAVR）后SVD的发生率、预测因素及预后情况。
我们回顾性分析了2005年至2015年间在我们中心接受生物人工主动脉瓣置换术的73例年龄≤50岁的连续患者。手术时的中位年龄为44岁（四分位间距[IQR]：39 - 47岁）。随访完成率为93.2%，中位随访时间为7.2年（IQR：5.5 - 9.5年）。累积随访瓣膜时间为545.5个瓣膜年。生物瓣膜SVD通过严格的超声心动图评估确定。
10/15年的总生存率以及10/12.5年无SVD生存率分别为89.6 ± 5.2%/81.5 ± 9.1%和73.5 ± 8.2%/41.9 ± 18.9%。SVD发生在bAVR后的中位时间为8.2年（IQR：6.0 - 9.9年）。在多变量模型中，年龄未被发现是SVD的独立预测因素，尽管≤30岁年龄组的SVD发生率较高。10/15年因SVD免于再次手术的比例为71.3 ± 14.1%/13.6 ± 12.3%。再次手术在首次bAVR后的中位时间为10.0年（IQR：8.9 - 11.9年），且与100%的12个月生存率相关。
在我们的研究中，SVD发生的速率和时间与其他研究中年龄较大组的情况相当。对瓣膜性能进行严格的超声心动图监测对于确定最终再次手术的合适时机至关重要。这种态度可以改善年轻患者bAVR的预后。
