Lau Christopher, Ram Eilon, Harik Lamia, Soletti Giovanni, Leith Jordan, Mack Charles A, Gambardella Ivancarmine, Gaudino Mario, Girardi Leonard N
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
J Thorac Cardiovasc Surg. 2025 Jun;169(6):1696-1703. doi: 10.1016/j.jtcvs.2024.07.046. Epub 2024 Jul 29.
We sought to evaluate outcomes of valve-sparing root replacement (VSRR) in patients with bicuspid aortopathy (BAV) versus other connective tissue disorder (CTD).
This was a single-center cohort study of consecutive patients undergoing VSRR via reimplantation from 2000 to 2023 with BAV or CTD. Operative outcomes, Kaplan-Meier survival estimates, and cumulative risk of reoperation and recurrent aortic insufficiency (AI) with the competing risk of death were assessed.
Of 516 patients who underwent VSRR, 109 (51.9%) had BAV and 101 (48.1%) had CTD. Patients with BAV were older (46.9 ± 10.4 vs 38.4 ± 14 years, P < .001) and more likely male (89.0% vs 56.4%, P < .001) and hypertensive (66.1% vs 28.7%, P < .001). Preoperative AI was similar (P = .57) between groups (30.3% mild, 18.3% moderate, 11.1% severe). Most patients had no/trivial immediate postoperative residual AI (96.3% vs 93.1%). Operative mortality was zero; postoperative adverse events were minimal. Mean clinical follow-up was 5.2 ± 4.4 years; 10-year survival was 95.6% versus 95.7% (P = .70). Echocardiographic follow-up was 3.9 ± 4.1 years; incidence of >2+ AI (9.7% vs 10.1%, P = 1.0) was similar between groups, whereas the incidence of moderate or greater aortic stenosis was greater with BAV (7.5% vs 0%, P = .02). Reoperation was low in both groups (3.7% vs 5.9%, P = .65). Competing risk analysis found no difference in reoperation hazard between BAV and CTD groups (hazard ratio, 0.36; 95% confidence interval, 0.07-1.81, P = .21).
Patients with BAV and CTD have excellent operative outcomes, no mortality, and minimal residual AI after VSRR. Although the incidence of recurrent AI was similar, patients with BAV are at risk for AS.
我们试图评估二叶式主动脉病变（BAV）患者与其他结缔组织疾病（CTD）患者行保留瓣膜主动脉根部置换术（VSRR）的结果。
这是一项单中心队列研究，纳入了2000年至2023年期间连续接受VSRR再植入手术的BAV或CTD患者。评估手术结果、Kaplan-Meier生存估计以及再手术和复发性主动脉瓣关闭不全（AI）的累积风险，并考虑死亡的竞争风险。
在516例行VSRR的患者中，109例（51.9%）患有BAV，101例（48.1%）患有CTD。BAV患者年龄更大（46.9±10.4岁 vs 38.4±14岁，P<.001），男性比例更高（89.0% vs 56.4%，P<.001），高血压患病率更高（66.1% vs 28.7%，P<.001）。术前AI在两组之间相似（P=.57）（轻度30.3%，中度18.3%，重度11.1%）。大多数患者术后即刻无/仅有轻微残余AI（96.3% vs 93.1%）。手术死亡率为零；术后不良事件极少。平均临床随访时间为5.2±4.4年；10年生存率分别为95.6%和95.7%（P=.70）。超声心动图随访时间为3.9±4.1年；两组间>2+AI的发生率相似（9.7% vs 10.1%，P=1.0），而BAV患者中度或更严重主动脉瓣狭窄的发生率更高（7.5% vs 0%，P=.02）。两组再手术率均较低（3.7% vs 5.9%，P=.65）。竞争风险分析发现BAV组和CTD组再手术风险无差异（风险比，0.36；95%置信区间，0.07-1.81，P=.21）。
BAV和CTD患者行VSRR后手术效果良好，无死亡率，残余AI极少。虽然复发性AI的发生率相似，但BAV患者有发生主动脉瓣狭窄的风险。
