Patel Parth Mukund, Olakunle Oreoluwa Elizabeth, Dong Andy, Chiou Edward, Wei Jane, Binongo Jose, Leshnower Bradley, Chen Edward Po
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA USA.
Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA USA.
Indian J Thorac Cardiovasc Surg. 2024 Mar;40(2):123-132. doi: 10.1007/s12055-023-01602-8. Epub 2023 Oct 19.
Clinical outcomes following various surgical intervention strategies for aortic root and valve pathology during repair of acute type A aortic syndromes were studied and compared.
From 2004 to 2019, 634 patients underwent acute type A aortic repair. Patients were divided into 4 groups: Valve Resuspension ( = 456), Isolated Valve Replacement (AVR) ( = 24), Valve and Root Replacement (ROOT) ( = 97), and Valve Sparing Root Replacement (VSRR) ( = 57). The primary endpoint was midterm survival and multivariable risk factor analysis was performed.
The mean age was 55.4 ± 13 years, 424 (67%) were male, and overall early mortality was 12%. Early mortality was 13%, 8%, 11%, and 7% for the Valve Resuspension, AVR, ROOT, and VSRR groups respectively, = 0.43. Five-year survival was 74%, 86%, 73%, and 84% for the Valve Resuspension, AVR, ROOT, and VSRR groups respectively, = 0.46. There was no difference in late stroke, renal failure, heart block, and late bleeding ( > 0.05 for all). At late follow-up, AVR and ROOT patients had a higher mean gradient versus Valve Resuspension and VSRR patients, < 0.0001. For the total cohort, risk factors for late mortality included preoperative peripheral vascular disease (hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.2-4.4, = 0.009) and preoperative dialysis (HR 2.8, 95% CI 1.3-6.1, = 0.01).
Mid-term survival following repair of acute type A aortic dissection is not independently associated with a specific type of aortic valve intervention. Native valve preservation leads to acceptable mid-term valve hemodynamics and should be the preferred therapy in this emergent clinical setting.
The online version contains supplementary material available at 10.1007/s12055-023-01602-8.
研究并比较急性A型主动脉综合征修复术中针对主动脉根部和瓣膜病变的各种手术干预策略后的临床结果。
2004年至2019年，634例患者接受了急性A型主动脉修复术。患者分为4组：瓣膜再悬吊术（n = 456）、单纯瓣膜置换术（AVR）（n = 24）、瓣膜和根部置换术（ROOT）（n = 97）以及保留瓣膜的根部置换术（VSRR）（n = 57）。主要终点是中期生存率，并进行多变量危险因素分析。
平均年龄为55.4±13岁，424例（67%）为男性，总体早期死亡率为12%。瓣膜再悬吊术、AVR、ROOT和VSRR组的早期死亡率分别为13%、8%、11%和7%，P = 0.43。瓣膜再悬吊术、AVR、ROOT和VSRR组的5年生存率分别为74%、86%、73%和84%，P = 0.46。晚期卒中、肾衰竭、心脏传导阻滞和晚期出血方面无差异（所有P>0.05）。在晚期随访中，AVR和ROOT患者的平均压差高于瓣膜再悬吊术和VSRR患者，P<0.0001。对于整个队列，晚期死亡的危险因素包括术前外周血管疾病（风险比（HR）2.3，95%置信区间（CI）1.2 - 4.4，P = 0.009）和术前透析（HR 2.8，95% CI 1.3 - 6.1，P = 0.01）。
急性A型主动脉夹层修复术后的中期生存与特定类型的主动脉瓣干预无独立相关性。保留自体瓣膜可获得可接受的中期瓣膜血流动力学，应是这种紧急临床情况下的首选治疗方法。
在线版本包含可在10.1007/s12055-023-01602-8获取的补充材料。
