Rosinski Brad F, Hodges Kevin, Vargo Patrick R, Roselli Eric E, Koprivanac Marijan, Tong Michael, Rajeswaran Jeevanantham, Blackstone Eugene H, Svensson Lars G
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2024 Jan;167(1):101-111.e4. doi: 10.1016/j.jtcvs.2023.07.038. Epub 2023 Jul 31.
To characterize residual aortic regurgitation (AR), identify its risk factors, and evaluate outcomes following aortic root replacement with aortic valve reimplantation.
From 2002 to 2020, 756 patients with a tricuspid aortic valve underwent elective reimplantation for aortic root aneurysm. AR on transthoracic echocardiograms before hospital discharge was graded as mild or greater. Machine learning was used to identify risk factors for residual AR and subsequent aortic valve reoperation.
Sixty-five patients (8.6%) had mild (58 [7.7%]) or moderate (7 [0.93%]) residual postoperative AR. They had more severe preoperative AR (38% vs 12%; P < .0001), thickened cusps (7.7% vs 2.2%; P = .008), aortic valve repair (38% vs 23%; P = .004), and multiple returns to cardiopulmonary bypass for additional repair (11% vs 3.3%; P = .003) than those without AR. Predictors of residual AR were severe preoperative AR, smaller aortic root graft, and concomitant cusp repair. At 10 years, patients with versus without residual AR had more moderate or severe AR (48% vs 7.0%; P < .0001) and freedom from reoperation was worse (89% vs 98%; P < .0001). Residual AR was a risk factor for early reoperation. Concomitant coronary bypass, lower body mass index, and lower ejection fraction were risk factors for late reoperation. Ten-year survival was similar among patients with and without residual AR (97% vs 93%; P = .43).
Residual AR after elective reimplantation of a tricuspid aortic valve for aortic root aneurysm is uncommon. Patients with severe preoperative AR and those who undergo valve repair have higher risk for residual AR, which can progress and increase risk of aortic valve reoperation.
描述残余主动脉瓣反流（AR）的特征，确定其危险因素，并评估主动脉根部置换加主动脉瓣再植入术后的结局。
2002年至2020年，756例三尖瓣主动脉瓣患者因主动脉根部瘤接受了择期再植入手术。出院前经胸超声心动图检查的AR分为轻度及以上。采用机器学习来确定残余AR和后续主动脉瓣再次手术的危险因素。
65例患者（8.6%）术后有轻度（58例[7.7%]）或中度（7例[0.93%]）残余AR。与无AR的患者相比，他们术前AR更严重（38%对12%；P<0.0001）、瓣叶增厚（7.7%对2.2%；P=0.008）、进行过主动脉瓣修复（38%对23%；P=0.004）以及多次返回体外循环进行额外修复（11%对3.3%；P=0.003）。残余AR的预测因素为术前严重AR、较小的主动脉根部移植物和同期瓣叶修复。10年时，有残余AR与无残余AR的患者相比，有更多中度或重度AR（48%对7.0%；P<0.0001），再次手术的自由度更差（89%对98%；P<0.0001）。残余AR是早期再次手术的危险因素。同期冠状动脉搭桥、较低的体重指数和较低的射血分数是晚期再次手术的危险因素。有和无残余AR的患者10年生存率相似（97%对93%；P=0.43）。
三尖瓣主动脉瓣因主动脉根部瘤择期再植入术后残余AR并不常见。术前严重AR的患者和接受瓣膜修复的患者残余AR风险更高，残余AR可能进展并增加主动脉瓣再次手术的风险。
