Mastrobuoni Stefano, Govers Pascal J, Veen Kevin M, Jahanyar Jama, van Saane Silke, Segreto Antonio, Zanella Luca, de Kerchove Laurent, Takkenberg Johanna J M, Arabkhani Bardia
Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Ann Cardiothorac Surg. 2023 May 31;12(3):149-158. doi: 10.21037/acs-2023-avs1-0038.
Current guidelines recommend valve-sparing aortic root replacement (VSRR) procedures over valve replacement for the treatment of root aneurysm. The reimplantation technique seems to be the most widely used valve-sparing technique, with excellent outcomes in mostly single-center studies. The aim of this systematic review and meta-analysis is to present a comprehensive overview of clinical outcomes after VSRR with the reimplantation technique, and potential differences for bicuspid aortic valve (BAV) phenotype.
We conducted a systematic literature search of papers reporting outcomes after VSRR that were published since 2010. Studies solely reporting on acute aortic syndromes or congenital patients were excluded. Baseline characteristics were summarized using sample size weighting. Late outcomes were pooled using inverse variance weighting. Pooled Kaplan-Meier (KM) curves for time-to-event outcomes were generated. Further, a microsimulation model was developed to estimate life expectancy and risks of valve-related morbidity after surgery.
Forty-four studies, with 7,878 patients, matched the inclusion criteria and were included for analysis. Mean age at operation was 50 years and almost 80% of patients were male. Pooled early mortality was 1.6% and the most common perioperative complication was chest re-exploration for bleeding (5.4%). Mean follow-up was 4.8±2.8 years. Linearized occurrence rates for aortic valve (AV) related complications such as endocarditis and stroke were below 0.3% patient-year. Overall survival was 99% and 89% at 1- and 10-year respectively. Freedom from reoperation was 99% and 91% after 1 and 10 years, respectively, with no difference between tricuspid and BAVs.
This systematic review and meta-analysis shows excellent short- and long-term results of valve-sparing root replacement with the reimplantation technique in terms of survival, freedom from reoperation, and valve related complications with no difference between tricuspid and BAVs.
当前指南推荐在治疗根部动脉瘤时采用保留瓣膜的主动脉根部置换术（VSRR）而非瓣膜置换术。再植入技术似乎是应用最广泛的保留瓣膜技术，在大多数单中心研究中取得了优异的结果。本系统评价和荟萃分析的目的是全面概述采用再植入技术的VSRR术后的临床结局，以及二叶式主动脉瓣（BAV）表型的潜在差异。
我们对2010年以来发表的报告VSRR术后结局的论文进行了系统的文献检索。仅报告急性主动脉综合征或先天性患者的研究被排除。使用样本量加权总结基线特征。使用逆方差加权汇总晚期结局。生成事件发生时间结局的合并Kaplan-Meier（KM）曲线。此外，还开发了一个微观模拟模型来估计手术后的预期寿命和瓣膜相关发病风险。
44项研究，共7878例患者，符合纳入标准并纳入分析。手术时的平均年龄为50岁，近80%的患者为男性。合并早期死亡率为1.6%，最常见的围手术期并发症是因出血而再次开胸（5.4%）。平均随访时间为4.8±2.8年。主动脉瓣（AV）相关并发症如心内膜炎和中风的线性化发生率低于0.3%/患者年。1年和10年时的总生存率分别为99%和89%。1年和10年后再次手术的免再手术率分别为99%和91%，三尖瓣和BAV之间无差异。
本系统评价和荟萃分析显示，采用再植入技术的保留瓣膜根部置换术在生存、免再手术和瓣膜相关并发症方面具有优异的短期和长期结果，三尖瓣和BAV之间无差异。
