Department of Cardiology and Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba, Curitiba, Brazil.
Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac487.
The aim of this study was to evaluate the impact of rheumatic heart disease (RHD) on the long-term outcomes of the Ross operation when compared to patients with bicuspid aortic valves (BAV).
We analysed patients with rheumatic disease and BAV who underwent a Ross operation between 1995 and 2020. The primary outcomes were late survival and reoperations on the pulmonary autograft and the right ventricular allograft. We also performed a propensity score analysis to adjust for differences in baseline characteristics. The cumulative incidence of the events in the matched cohorts was compared using the Fine-Gray model. There were 147 patients with rheumatic disease and 314 with bicuspid valves. In the unmatched population, patients with rheumatic disease were younger, more symptomatic, had worse left ventricular function and were more likely to present a preoperative diagnosis of aortic insufficiency. Propensity matching resulted in 86 pairs with similar baseline characteristics. Compared with those with bicuspid valves, rheumatic patients had similar 20-year survival both in the unmatched (RHD = 67.8% vs BAV = 79.7%, P = 0.27] and matched cohorts (RHD = 72.5% vs BAV = 82.9%, P = 0.46). Cumulative incidence of reoperations on the pulmonary autograft after 20 years was also comparable between them in the unmatched (RHD 13.4% vs BAV 14.4%, P = 0.67) and matched patients (RHD 11.6% vs BAV 21.1%, P = 0.47). Pulmonary autograft dysfunction due to rheumatic involvement was detected in only three occasions. Cumulative incidence of reoperations on the right-sided allograft was higher in the unmatched cohort (RHD = 5.5% vs BAV = 16.7%, P = 0.035) but became nonsignificant after propensity score matching (RHD = 9.9% vs BAV = 32.3%, P = 0.051). The cumulative incidence of all Ross-related reoperations was similar in both groups.
Among patients undergoing Ross operation, patients with RHD had similar long-term survival and rates of reoperations, when compared to patients with BAV.
本研究旨在评估与二叶式主动脉瓣（BAV）患者相比，风湿性心脏病（RHD）对 Ross 手术长期结果的影响。
我们分析了 1995 年至 2020 年间接受 Ross 手术的风湿性疾病和 BAV 患者。主要结局是肺自体移植物和右心室同种异体移植物的晚期存活和再次手术。我们还进行了倾向评分分析以调整基线特征的差异。使用 Fine-Gray 模型比较匹配队列中的事件累积发生率。在未匹配的人群中，风湿性疾病患者更年轻，症状更严重，左心室功能更差，术前更可能诊断为主动脉瓣关闭不全。倾向匹配产生了 86 对具有相似基线特征的患者。与 BAV 患者相比，风湿性疾病患者在未匹配人群中（RHD=67.8% vs. BAV=79.7%，P=0.27）和匹配队列中（RHD=72.5% vs. BAV=82.9%，P=0.46）的 20 年生存率相似。在未匹配的患者中，20 年后肺自体移植物再次手术的累积发生率也相似（RHD 13.4% vs. BAV 14.4%，P=0.67）和匹配的患者（RHD 11.6% vs. BAV 21.1%，P=0.47）。仅在三次情况下发现风湿性疾病导致的肺自体移植物功能障碍。在未匹配的队列中，右侧同种异体移植物再次手术的累积发生率更高（RHD=5.5% vs. BAV=16.7%，P=0.035），但在倾向评分匹配后无统计学意义（RHD=9.9% vs. BAV=32.3%，P=0.051）。两组的所有 Ross 相关再次手术的累积发生率相似。
在接受 Ross 手术的患者中，与 BAV 患者相比，RHD 患者的长期生存率和再次手术率相似。
