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主动脉瓣叶修复不影响改良主动脉瓣再植入治疗三尖瓣主动脉瓣的耐久性。

Aortic valve cusp repair does not affect durability of modified aortic valve reimplantation for tricuspid aortic valves.

作者信息

Hodges Kevin, Rosinski Bradley F, Roselli Eric E, Rajeswaran Jeevanantham, Griffin Brian, Vargo Patrick R, Koprivanac Marijan, Tong Michael, Blackstone Eugene H, Svensson Lars G

机构信息

Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.

Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.

出版信息

JTCVS Open. 2023 Jul 22;16:105-122. doi: 10.1016/j.xjon.2023.06.021. eCollection 2023 Dec.

Abstract

OBJECTIVE

During aortic valve reimplantation, cusp repair may be needed to produce a competent valve. We investigated whether the need for aortic valve cusp repair affects aortic valve reimplantation durability.

METHODS

Patients with tricuspid aortic valves who underwent aortic valve reimplantation from January 2002 to January 2020 at a single center were retrospectively analyzed. Propensity matching was used to compare outcomes between patients who did and did not require aortic valve cusp repair.

RESULTS

Cusp repair was performed in 181 of 756 patients (24%). Patients who required cusp repair were more often male, were older, had more aortic valve regurgitation, and less often had connective tissue disease. Patients who underwent cusp repair had longer aortic clamp time (124 ± 43 minutes vs 107 ± 36 minutes,  = .001). In-hospital outcomes were similar between groups and with no operative deaths. A total of 98.3% of patients with cusp repair and 99.3% of patients without cusp repair had mild or less aortic regurgitation at discharge. The median follow-up was 3.9 and 3.2 years for the cusp repair and no cusp repair groups, respectively. At 10 years, estimated prevalence of moderate or more aortic regurgitation was 12% for patients with cusp repair and 7.0% for patients without cusp repair ( = .30). Mean aortic valve gradients were 6.2 mm Hg and 8.0 mm Hg, respectively ( = .01). Ten-year freedom from reoperation was 99% versus 99% ( = .64) in the matched cohort and 97% versus 97%, respectively ( = .30), in the unmatched cohort. Survival at 10 years was 98% after cusp repair and 93% without cusp repair ( = .05).

CONCLUSIONS

Aortic valve reimplantation for patients with tricuspid aortic valves has excellent long-term results. Need for aortic valve cusp repair does not affect long-term outcomes and should not deter surgeons from performing valve-sparing surgery.

摘要

目的

在主动脉瓣再植入过程中,可能需要进行瓣叶修复以形成一个功能良好的瓣膜。我们研究了主动脉瓣瓣叶修复的需求是否会影响主动脉瓣再植入的耐久性。

方法

对2002年1月至2020年1月在单一中心接受主动脉瓣再植入的三尖瓣主动脉瓣患者进行回顾性分析。采用倾向匹配法比较需要和不需要主动脉瓣瓣叶修复的患者的结局。

结果

756例患者中有181例(24%)进行了瓣叶修复。需要瓣叶修复的患者男性更多、年龄更大、主动脉瓣反流更多,而结缔组织病较少见。进行瓣叶修复的患者主动脉阻断时间更长(124±43分钟对107±36分钟,P = 0.001)。两组的院内结局相似,且无手术死亡。共有98.3%进行瓣叶修复的患者和99.3%未进行瓣叶修复的患者在出院时存在轻度或更低程度的主动脉反流。瓣叶修复组和未进行瓣叶修复组的中位随访时间分别为3.9年和3.2年。在10年时,进行瓣叶修复的患者中度或更严重主动脉反流的估计患病率为12%,未进行瓣叶修复的患者为7.0%(P = 0.30)。平均主动脉瓣压差分别为6.2 mmHg和8.0 mmHg(P = 0.01)。在匹配队列中,10年再次手术自由度为99%对99%(P = 0.64),在未匹配队列中分别为97%对97%(P = 0.30)。瓣叶修复后10年生存率为98%,未进行瓣叶修复为93%(P = 0.05)。

结论

三尖瓣主动脉瓣患者的主动脉瓣再植入具有出色的长期结果。主动脉瓣瓣叶修复的需求不影响长期结局,不应阻碍外科医生进行保留瓣膜手术。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4922/10774985/29d339455806/ga1.jpg

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