大卫手术：300 例患者 21 年经验。
David Procedure: A 21-year Experience With 300 Patients.
机构信息
Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France.
Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France; Module for Education and Research Collaboration in Statistics, University of Lille, GIVRE-MERCS, Lille, France.
出版信息
Ann Thorac Surg. 2023 Jun;115(6):1403-1410. doi: 10.1016/j.athoracsur.2022.04.058. Epub 2022 May 26.
BACKGROUND
Valve-sparing aortic root replacement with the David procedure is an alternative to the Bentall procedure in patients with aortic root aneurysm. The aim of this study was to describe our long-term experience with this technique and the predictive factors of late failure.
METHODS
Between January 1998 and August 2019, 300 consecutive patients underwent a David procedure. Clinical and echocardiographic early- and long-term outcomes were analyzed. Median follow-up was 7.0 years (range, 4.1-11.5), with 98.3% complete.
RESULTS
Early mortality was 1%. No early valve-related reoperations occurred. There were 9 cardiac-related deaths and 22 reinterventions (19 valve-related). All patients survived reoperation. In 3 patients reintervention consisted of transcatheter aortic valve implantation. Overall survival rates were 95.3% (95% confidence interval [CI], 92.0-97.2), 91.1% (95% CI, 86.5-94.2), and 82.9% (95% CI, 75.3-88.4) at 5, 10, and 15 years, respectively. Freedom from postoperative aortic insufficiency (AI) grade ≥ 2 was 84.8% (95% CI, 79.9-88.6) and 74.3% (95% CI, 67.4-79.9) at 5 and 10 years, respectively. Freedom from reintervention for aortic valve disease was 97.1% (95% CI, 94.2-98.5), 92.9% (95% CI, 88.2-95.7), and 92.5% (95% CI, 87.1-95.7) at 5, 10, and 15 years, respectively. Preoperative AI ≥ 2 (hazard ratio, 1.782; 95% CI, 1.352-2.350) and a ventriculoaortic junction ≥ 29 mm (hazard ratio, 3.379; 95% CI, 1.726-6.616) were predictive factors for postoperative AI ≥ 2 in a multivariate analysis (P < .001).
CONCLUSIONS
Preoperative AI ≥ 2 and a ventriculoaortic junction ≥ 29 mm were identified as risk factors for late postoperative AI ≥ 2.
背景
在主动脉根部瘤患者中，行保留瓣膜的主动脉根部替换术（David 手术）是 Bentall 手术的替代方法。本研究旨在描述我们使用该技术的长期经验，以及晚期失败的预测因素。
方法
1998 年 1 月至 2019 年 8 月期间，300 例连续患者接受了 David 手术。分析了临床和超声心动图的早期和长期结果。中位随访时间为 7.0 年（范围 4.1-11.5 年），随访完成率为 98.3%。
结果
早期死亡率为 1%。无早期与瓣膜相关的再次手术。发生 9 例心脏相关死亡和 22 例再介入（19 例与瓣膜相关）。所有患者均存活并完成再次手术。3 例患者的再介入包括经导管主动脉瓣植入术。总体生存率分别为 95.3%（95%置信区间 [CI]，92.0-97.2）、91.1%（95% CI，86.5-94.2）和 82.9%（95% CI，75.3-88.4），分别在术后 5、10 和 15 年。术后主动脉瓣关闭不全（AI）≥2 级的无复发率分别为 84.8%（95% CI，79.9-88.6）和 74.3%（95% CI，67.4-79.9），分别在术后 5 年和 10 年。因主动脉瓣疾病再次干预的无复发率分别为 97.1%（95% CI，94.2-98.5）、92.9%（95% CI，88.2-95.7）和 92.5%（95% CI，87.1-95.7），分别在术后 5 年、10 年和 15 年。多变量分析显示，术前 AI≥2（风险比，1.782；95% CI，1.352-2.350）和主动脉瓣环下 29mm 以上（风险比，3.379；95% CI，1.726-6.616）是术后 AI≥2 的预测因素（P<0.001）。
结论
术前 AI≥2 和主动脉瓣环下 29mm 以上被确定为术后晚期 AI≥2 的危险因素。
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