Leshnower Bradley G, Farrington Woodrow J, Huckaby Lauren V, Keeling William B, Zellner Alysa B, Chen Edward P
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Ann Thorac Surg. 2025 Jan;119(1):101-107. doi: 10.1016/j.athoracsur.2024.09.007. Epub 2024 Sep 16.
Valve preservation in acute type A aortic dissection (ATAAD) can be accomplished with root repair or replacement. Long-term valve durability with root repair has been established, but limited data exist regarding long-term durability of valve-sparing root replacement (VSRR). In this study, long-term results of VSRR were compared with root repair in ATAAD.
From 2005 to 2023, 866 patients underwent ATAAD repair, of which 675 underwent root repair and 191 underwent root replacement (VSRR, n = 65; Bentall, n =126). VSRR patients were compared with 123 patients who underwent valve resuspension and root repair with postoperative echocardiograms ≥1 year.
VSRR patients were younger (VSRR, 44 ± 11 years vs root repair, 55 ± 13 years; P < .001). Preoperatively, 57% of VSRR and 35% of root repair patients had moderate or more aortic insufficiency. Cardiopulmonary bypass and myocardial ischemia times were significantly longer in VSRR (P < .001). Postoperative echocardiograms with ≥1 year follow-up were analyzed in 58 VSRR patients with median follow-up of 4.8 years (interquartile range, 3-12 years) and in 123 root repair patients with median follow-up of 3.6 years (interquartile range, 3-8 years). At 10 years, VSRR patients had superior freedom from more than mild aortic insufficiency (VSRR, 91% vs root repair, 49%; P < .001). At 10 years, freedom from aortic valve replacement was equivalent (VSRR, 98% vs root repair, 92%; P = .269).
VSRR provides equivalent long-term valve durability as root repair in ATAAD, even in patients with moderate or severe aortic insufficiency. In select young patients who require root replacement during ATAAD repair, VSRR represents an ideal therapy.
急性A型主动脉夹层（ATAAD）中的瓣膜保留可通过根部修复或置换来实现。根部修复后的瓣膜长期耐用性已得到证实，但关于保留瓣膜的根部置换（VSRR）的长期耐用性的数据有限。在本研究中，对ATAAD患者VSRR与根部修复的长期结果进行了比较。
2005年至2023年，866例患者接受了ATAAD修复，其中675例接受了根部修复，191例接受了根部置换（VSRR，n = 65；Bentall手术，n = 126）。将VSRR患者与123例接受瓣膜重新悬吊和根部修复且术后超声心动图检查≥1年的患者进行比较。
VSRR患者更年轻（VSRR组，44±11岁；根部修复组，55±13岁；P <.001）。术前，57%的VSRR患者和35%的根部修复患者存在中度或更严重的主动脉瓣关闭不全。VSRR患者的体外循环和心肌缺血时间明显更长（P <.001）。对58例VSRR患者（中位随访4.8年，四分位间距3 - 12年）和123例根部修复患者（中位随访3.6年，四分位间距3 - 8年）进行了随访≥1年的术后超声心动图分析。在10年时，VSRR患者无中度以上主动脉瓣关闭不全的自由度更高（VSRR组为91%，根部修复组为49%；P <.001）。在10年时，无需进行主动脉瓣置换的自由度相当（VSRR组为98%，根部修复组为92%；P =.269）。
在ATAAD中，VSRR与根部修复具有相当的长期瓣膜耐用性，即使是在存在中度或重度主动脉瓣关闭不全的患者中也是如此。在ATAAD修复期间需要进行根部置换的特定年轻患者中，VSRR是一种理想的治疗方法。
