Makkinejad Alexander, Monaghan Katelyn, Chen Sarah A, Wu Xiaoting, Ling Carol, Kim Karen, Fukuhara Shinichi, Patel Himanshu J, Pagani Francis, Deeb G Michael, Yang Bo
Department of Surgery, UF Health, University of Florida, Gainesville, Florida.
Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2025 Mar;119(3):568-575. doi: 10.1016/j.athoracsur.2024.07.022. Epub 2024 Aug 3.
We aimed to determine the effect of aortic annular enlargement on the midterm outcomes of aortic valve replacement surgery by comparing patients with the same-sized (≤23 mm) native aortic annuli.
From January 2011 to June 2022, 1328 patients underwent isolated aortic valve replacement-1163 without aortic annular enlargement (AVR group) and 165 with aortic annular enlargement (AVR+AAE group). Propensity score matching identified 112 pairs, controlling for native aortic annulus diameter, age, sex, diabetes, chronic lung disease, dialysis, ejection fraction, prior cardiac surgery, indication, hypertension, dyslipidemia, valve type, prior stroke, prior myocardial infarction, and case status.
Demographic and preoperative variables were similar, except body surface area was larger in the AVR+AAE group (2.1 m vs 1.9 m). Median native aortic annulus diameter was 23 mm in both groups. Median prosthesis size was 25 in the AVR+AAE group and 23 in the AVR group. The AVR+AAE group had longer cardiopulmonary bypass (143 vs 111 minutes) and cross-clamp (115 vs 82 minutes) times. Incidences of perioperative complications, including operative mortality (1.8% AVR+AAE vs 3.6% AVR) were similar between groups. Survival at 6 years was 98% in the AVR+AAE group and 74% in the AVR group (P = .016). Aortic annular enlargement was an independent protective factor for midterm mortality, with a hazard ratio of 0.19 (P = .006). The rate of moderate/severe patient-prosthesis mismatch was 19% in the AVR+AAE group and 31% in the AVR group (P = .16).
Patients with small native aortic annuli (≤23 mm) undergoing isolated aortic valve replacement may benefit from aortic annular enlargement.
我们旨在通过比较主动脉瓣环大小相同（≤23mm）的患者，来确定主动脉瓣环扩大对主动脉瓣置换手术中期结果的影响。
2011年1月至2022年6月，1328例患者接受了单纯主动脉瓣置换术，其中1163例未行主动脉瓣环扩大（AVR组），165例进行了主动脉瓣环扩大（AVR+AAE组）。倾向评分匹配确定了112对患者，控制因素包括主动脉瓣环直径、年龄、性别、糖尿病、慢性肺病、透析、射血分数、既往心脏手术史、手术指征、高血压、血脂异常、瓣膜类型、既往卒中史、既往心肌梗死史及病例状态。
除AVR+AAE组体表面积较大（2.1m²对1.9m²）外，两组的人口统计学和术前变量相似。两组主动脉瓣环直径中位数均为23mm。AVR+AAE组人工瓣膜尺寸中位数为25，AVR组为23。AVR+AAE组体外循环时间（143分钟对111分钟）和主动脉阻断时间（115分钟对82分钟）更长。两组围手术期并发症发生率，包括手术死亡率（AVR+AAE组为1.8%，AVR组为3.6%）相似。AVR+AAE组6年生存率为98%，AVR组为74%（P = 0.016）。主动脉瓣环扩大是中期死亡率的独立保护因素，风险比为0.19（P = 0.006）。AVR+AAE组中重度人工瓣膜-患者不匹配率为19%，AVR组为31%（P = 0.16）。
接受单纯主动脉瓣置换术的小主动脉瓣环（≤23mm）患者可能从主动脉瓣环扩大中获益。
