Holst Theresa, Petersen Johannes, Friedrich Sarah, Waschki Benjamin, Sinning Christoph, Rybczynski Meike, Reichenspurner Hermann, Girdauskas Evaldas
Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 42, 20246 Hamburg, Germany.
Department of Cardiothoracic Surgery, Augsburg University Hospital, Stenglinstraße 2, 86156 Augsburg, Germany.
J Cardiovasc Dev Dis. 2023 Mar 23;10(4):138. doi: 10.3390/jcdd10040138.
: Exercise capacity and patient-reported outcomes are increasingly considered crucial following aortic valve (AV) surgery in non-elderly adults. We aimed to prospectively evaluate the effect of native valve preservation compared with prosthetic valve replacement. From October 2017 to August 2020, 100 consecutive non-elderly patients undergoing surgery for severe AV disease were included. Exercise capacity and patient-reported outcomes were evaluated upon admission, and 3 months and 1 year postoperatively. In total, 72 patients underwent native valve-preserving procedures (AV repair or Ross procedure, NV group), and 28 patients, prosthetic valve replacement (PV group). Native valve preservation was associated with an increased risk of reoperation (weighted hazard ratio: 10.57 (95% CI: 1.24-90.01), = 0.031). The estimated average treatment effect on six-minute walking distance in NV patients at 1 year was positive, but not significant (35.64 m; 95% CI: -17.03-88.30, adj. = 0.554). The postoperative physical and mental quality of life was comparable in both groups. Peak oxygen consumption and work rate were better at all assessment time points in NV patients. Marked longitudinal improvements in walking distance (NV, +47 m (adj. < 0.001); PV, +25 m (adj. = 0.004)) and physical (NV, +7 points (adj. = 0.023); PV, +10 points (adj. = 0.005)) and mental quality of life (NV, +7 points (adj. < 0.001); PV, +5 points (adj. = 0.058)) from the preoperative period to the 1-year follow-up were observed. At 1 year, there was a tendency of more NV patients reaching reference values of walking distance. Despite the increased risk of reoperation, physical and mental performance markedly improved after native valve-preserving surgery and was comparable to that after prosthetic aortic valve replacement.
在非老年成人主动脉瓣（AV）手术后，运动能力和患者报告的结局越来越被认为至关重要。我们旨在前瞻性评估保留自体瓣膜与人工瓣膜置换相比的效果。2017年10月至2020年8月，纳入了100例连续接受严重AV疾病手术的非老年患者。在入院时、术后3个月和1年评估运动能力和患者报告的结局。总共72例患者接受了保留自体瓣膜的手术（AV修复或Ross手术，NV组），28例患者接受了人工瓣膜置换（PV组）。保留自体瓣膜与再次手术风险增加相关（加权风险比：10.57（95%CI：1.24 - 90.01），P = 0.031）。NV组患者1年时六分钟步行距离的估计平均治疗效果为阳性，但不显著（35.64米；95%CI： - 17.03 - 88.30，校正P = 0.554）。两组术后的身体和心理健康生活质量相当。在所有评估时间点，NV组患者的峰值耗氧量和工作率更好。从术前到1年随访，步行距离（NV组增加47米（校正P < 0.001）；PV组增加25米（校正P = 0.004））以及身体（NV组增加7分（校正P = 0.023）；PV组增加10分（校正P = 0.005））和心理健康生活质量（NV组增加7分（校正P < 0.001）；PV组增加5分（校正P = 0.058））有显著的纵向改善。在1年时，有更多NV组患者达到步行距离参考值的趋势。尽管再次手术风险增加，但保留自体瓣膜手术后身体和心理表现明显改善，且与人工主动脉瓣置换术后相当。
