Gofus Ján, Karalko Mikita, Fila Petr, Ondrášek Jiří, Schäfers Hans-Joachim, Kolesár Adrian, Lansac Emmanuel, El-Hamamsy Ismail, de Kerchove Laurent, Dinges Christian, Hlubocký Jaroslav, Němec Petr, Tuna Martin, Vojáček Jan
Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czechia.
Department of Cardiac Surgery and Transplantation Brno, Faculty of Medicine, Masaryk University, Brno, Czechia.
Front Cardiovasc Med. 2022 Sep 8;9:900426. doi: 10.3389/fcvm.2022.900426. eCollection 2022.
Unicuspid aortic valve (UAV) is the second most common underlying cause of aortic valve dysfunction in young adults after the bicuspid valve. The valve may be replaced (for example by pulmonary autograft) or repaired using the bicuspidization technique. The aim of our study was to compare short- and mid-term outcomes of Ross procedure with bicuspidization in patients with severe UAV dysfunction.
This was a multi-center retrospective observational cohort study comparing data from two dedicated Ross centers in the Czech Republic with bicuspidization outcomes provided by AVIATOR registry. As for the Ross group, only the patients with UAV were included. Primary endpoint was mid-term freedom from reintervention. Secondary endpoints were mid-term freedom from major adverse events, endocarditis and pacemaker implantation.
Throughout the study period, 114 patients underwent the Ross procedure (years 2009-2020) and 126 patients underwent bicuspidization (years 2006-2019). The bicuspidization group was significantly younger and presented with a higher degree of dyspnea, a lower degree of aortic valve stenosis and more often with pure regurgitation. The primary endpoint occurred more frequently in the bicuspidization group than in the Ross group - 77.9 vs. 97.9 % at 5 years and 68.4 vs. 75.2 % at 10 years ( < 0.001). There was no difference in secondary endpoints.
Ross procedure might offer a significantly lower mid-term risk of reintervention than bicuspidization in patients with UAV. Both procedures have comparable survival and risk of other short- and mid-term complications postoperatively.
单叶主动脉瓣（UAV）是年轻成年人主动脉瓣功能障碍的第二大常见潜在病因，仅次于二叶式主动脉瓣。该瓣膜可进行置换（例如采用自体肺动脉瓣）或使用二叶化技术进行修复。我们研究的目的是比较Ross手术与二叶化技术在严重UAV功能障碍患者中的短期和中期结局。
这是一项多中心回顾性观察队列研究，将捷克共和国两个专门的Ross中心的数据与AVIATOR注册中心提供的二叶化技术结局数据进行比较。至于Ross组，仅纳入了患有UAV的患者。主要终点是中期免于再次干预。次要终点是中期免于发生主要不良事件、心内膜炎和起搏器植入。
在整个研究期间，114例患者接受了Ross手术（2009 - 2020年），126例患者接受了二叶化技术（2006 - 2019年）。二叶化技术组患者明显更年轻，呼吸困难程度更高，主动脉瓣狭窄程度更低，且更常表现为单纯反流。主要终点在二叶化技术组的发生率高于Ross组——5年时分别为77.9%和97.9%，10年时分别为68.4%和75.2%（<0.001）。次要终点方面无差异。
对于患有UAV的患者，Ross手术中期再次干预的风险可能显著低于二叶化技术。两种手术在术后生存及其他短期和中期并发症风险方面具有可比性。
