Szalkiewicz Philipp, Gökler Johannes, Dietl Wolfgang, Ehrlich Marek, Holzinger Christoph, Laufer Günther, Wiedemann Dominik
Clinical Department of Cardiac Surgery, University Department of Surgery, Medical University of Vienna, Vienna, Austria.
Clinical Department of Cardiac Surgery, University Hospital of St. Pölten, St. Pölten, Austria.
Front Cardiovasc Med. 2022 Jul 25;9:953672. doi: 10.3389/fcvm.2022.953672. eCollection 2022.
Indication for Reduction of Ascending Aortoplasty (RAA) and long-term outcomes remain unclear. This study analyzed the outcomes after nonreinforced RAA in two Austrian centers.
Patients with RAA at two Austrian centers between 6/2,009 and 6/2,017 were retrospectively analyzed. Aortic diameters were measured by CT pre- and post-operatively. Patients were assigned according to valve morphology and imaging modality.
Overall, 253 patients underwent RAA [women: 30.8%; median age 74 (63-79) years] with a mean preoperative ascending diameter of 44.7 (±3.5) mm. RAA-related postoperative adverse events occurred in 1.2% ( = 3) over a follow-up of a median of 3.8 (2.4-5.5) years: One type A aortic dissection, one lethal aortic rupture at the suture line, and one suture line bleeding with cardiac tamponade and need of surgical revision. The overall survival rate was 89.7%. Aortic valve morphology itself was no risk factor for mortality (Log-Rank: 0.942). One hundred and forty patients had a tricuspid [TAV: (55.3%)] aortic valve and 113 patients had a bicuspid aortic valve [BAV: (44.7%)]. Redilatation to a diameter >50 mm according to CT follow-up occurred in 5.7% ( = 5 of 87). One patient needed reoperation with RAA and aortic valve replacement due to a prosthesis-patient mismatch after aortic valve replacement and aortic redilatation.
Non-reinforced RAA is a safe, feasible, and reproducible procedure with low rates of perioperative complications in selected patients primarily undergoing aortic valve repair with a dilated ascending aorta. Aortic valve morphology has no impact on mortality after RAA.
升主动脉成形术（RAA）的指征及长期预后仍不明确。本研究分析了奥地利两个中心非强化RAA术后的结果。
对2009年6月至2017年6月期间奥地利两个中心接受RAA的患者进行回顾性分析。术前和术后通过CT测量主动脉直径。根据瓣膜形态和成像方式对患者进行分组。
总体而言，253例患者接受了RAA[女性：30.8%；中位年龄74（63 - 79）岁]，术前升主动脉平均直径为44.7（±3.5）mm。在中位随访3.8（2.4 - 5.5）年期间，1.2%（n = 3）发生了与RAA相关的术后不良事件：1例A型主动脉夹层，1例缝合线处致命性主动脉破裂，1例缝合线出血伴心脏压塞且需要手术翻修。总生存率为89.7%。主动脉瓣形态本身不是死亡的危险因素（对数秩检验：0.942）。140例患者为三尖瓣[TAV：（55.3%）]主动脉瓣，113例患者为二叶式主动脉瓣[BAV：（44.7%）]。根据CT随访，5.7%（87例中的5例）患者的主动脉直径再次扩张至>50 mm。1例患者因主动脉瓣置换术后人工瓣膜与患者不匹配及主动脉再次扩张，需要再次手术行RAA及主动脉瓣置换。
对于主要接受主动脉瓣修复且升主动脉扩张的特定患者，非强化RAA是一种安全、可行且可重复的手术，围手术期并发症发生率低。主动脉瓣形态对RAA术后死亡率无影响。
