在单一教学中心进行保留主动脉瓣根部置换术的25年经验。

Twenty-five year experience with aortic valve-sparing root replacement in a single teaching center.

作者信息

Sromicki Juri, Van Hemelrijck Mathias, Schmiady Martin O, Greutmann Matthias, Bonassin Tempesta Francesca, Mestres Carlos-A, Vogt Paul R, Carrel Thierry P, Holubec Tomáš

机构信息

Department of Cardiac Surgery, University Zurich and University Hospital Zurich, Zurich, Switzerland.

Department of Cardiology, University Zurich and University Hospital Zurich, Zurich, Switzerland.

出版信息

Front Cardiovasc Med. 2023 Mar 10;10:1104149. doi: 10.3389/fcvm.2023.1104149. eCollection 2023.

DOI:10.3389/fcvm.2023.1104149

PMID:36970369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10036903/

Abstract

OBJECTIVES

Aortic valve-sparing root replacement (AVSRR) is a technically demanding procedure. In experienced centers it offers excellent short- and long-term results, making the procedure an attractive alternative for aortic root replacement especially in young patients. The aim of this study was to analyze long-term results of AVSRR using the David operation in our institution over the last 25 years.

METHODS

This is a single-center retrospective analysis of outcomes of David operations performed in a teaching institution not running a large AVSRR-program. Pre-, intra- and postoperative data were collected from the institutional electronic medical record system. Follow-up data were collected through direct contact of the patients and their cardiologists/primary care physicians.

RESULTS

Between 02/1996 and 11/2019, 131 patients underwent David operation in our institution by a total of 17 different surgeons. Median age was 48 (33-59), 18% were female. Elective surgery was performed in 89% of the cases, 11% were operated as emergency in the setting of an acute aortic dissection. Connective tissue disease was present in 24% and 26% had a bicuspid aortic valve. At hospital admission 61% had aortic regurgitation grade ≥3, 12% were in functional NYHA-class ≥III. 30-day mortality was 2%, 97% of the patients were discharged with aortic regurgitation ≤2. In 10-year follow-up, 15 (12%) patients had to be re-operated because of root-related complications. Seven patients (47%) received a transcatheter aortic valve implantation, 8 (53%) required surgical replacement of the aortic valve or a Bentall-De Bono operation. Estimated reoperation-free survival at 5 and 10 years was 93.5% ± 2.4% and 87.0% ± 3.5%, respectively. Subgroup analysis showed no differences in reoperation-free survival for patients presenting with a bicuspid valve or preoperative aortic regurgitation ≥3. However a preoperative left ventricular end diastolic diameter of ≥5.5 cm was associated with worse outcome.

CONCLUSION

David operations can be performed with excellent perioperative and 10-year follow-up outcomes in centers not running large AVSRR-programs.

摘要

目的

保留主动脉瓣的根部置换术（AVSRR）是一项技术要求很高的手术。在经验丰富的中心，该手术能带来出色的短期和长期效果，使其成为主动脉根部置换术颇具吸引力的替代方案，尤其是对于年轻患者。本研究的目的是分析过去25年里我们机构采用大卫手术进行AVSRR的长期效果。

方法

这是对一家未开展大型AVSRR项目的教学机构中进行的大卫手术结果的单中心回顾性分析。术前、术中和术后数据均从机构电子病历系统中收集。随访数据通过直接联系患者及其心脏病专家/初级保健医生来收集。

结果

1996年2月至2019年11月期间，我们机构共有17位不同的外科医生为131例患者实施了大卫手术。患者中位年龄为48岁（33 - 59岁），女性占18%。89%的病例为择期手术，11%是在急性主动脉夹层情况下作为急诊进行手术。24%的患者存在结缔组织病，26%有二叶式主动脉瓣。入院时，61%的患者主动脉反流分级≥3级，12%的心功能纽约心脏协会（NYHA）分级≥III级。30天死亡率为2%，97%的患者出院时主动脉反流≤2级。在10年随访中，15例（12%）患者因根部相关并发症需要再次手术。7例（47%）患者接受了经导管主动脉瓣植入术，8例（53%）需要进行主动脉瓣手术置换或Bentall-De Bono手术。5年和10年的无再次手术生存率估计分别为93.5%±2.4%和87.0%±3.5%。亚组分析显示，二叶式瓣膜患者或术前主动脉反流≥3级的患者在无再次手术生存率方面无差异。然而，术前左心室舒张末期直径≥5.5 cm与较差的预后相关。