Zito Francesco, Veen Kevin M, Melina Giovanni, Lansac Emmanuel, Schäfers Hans-Joachim, de Kerchove Laurent, Takkenberg Johanna J M, Kluin Jolanda, Mokhles M Mostafa
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Cardiac Surgery, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.
Eur J Cardiothorac Surg. 2025 Mar 4;67(3). doi: 10.1093/ejcts/ezaf020.
Aortic valve repair/sparing techniques have been established as effective treatments for aortic regurgitation and/or aortic aneurysms. However, concerns remain regarding long-term durability, reproducibility and patient selection. This study aims to asses long-term clinical and echocardiographic outcomes, with a focus on aortic regurgitation grade and left ventricular ejection fraction evolution, in adults undergoing these procedures.
Adult patients in the Heart Valve Society Aortic Valve Database, undergoing any aortic valve repair/sparing technique were included. Time-to-event analyses were used for clinical outcomes and mixed-effects models for left ventricular ejection fraction and aortic regurgitation grade evolution. Techniques: isolated valve repair (group 1), ascending aortic replacement + valve repair (group 2), partial-root replacement ± valve repair (group 3) and valve-sparing root replacement ± valve repair (group 4).
Survival at 10 years was comparable to survival of the matched-general-population in each group. The 10-year cumulative incidence of reintervention was 19.5% [95% confidence interval (CI) 16.70-22.40%] in group 1 [including only double external annuloplasty in group 1; reintervention was not significantly different between techniques (P = 0.112)]; 13.8% (95% CI 10.10-18.10%) in group 2; 12.7% (95% CI 5.50-22.90%) in group 3; and 8.5% (95% CI 7.00-10.10%) in group 4 (P < 0.001). Severe preoperative aortic regurgitation grade [hazard ratio 1.95 (95% CI 1.19-3.21), P < 0.001] and left ventricular end-diastolic diameter [hazard ratio 1.03 (95% CI 1.00-1.05), P < 0.001] were predictive of reintervention in group 4; patch use was a predictor in all groups. The predicted left ventricular ejection fraction (%) initially increased (P < 0.001) and then stabilized.
This study found that aortic valve repair/sparing techniques provide viable and effective treatment options that should be considered for all eligible patients with aortic regurgitation and/or aortic root/ascending aortic aneurysms, given their potential to restore life expectancy and provide good haemodynamic outcomes with an acceptable hazard of reintervention.
主动脉瓣修复/保留技术已被确立为治疗主动脉瓣反流和/或主动脉瘤的有效方法。然而，对于其长期耐久性、可重复性和患者选择仍存在担忧。本研究旨在评估接受这些手术的成年患者的长期临床和超声心动图结果，重点关注主动脉瓣反流分级和左心室射血分数的变化。
纳入心脏瓣膜协会主动脉瓣数据库中接受任何主动脉瓣修复/保留技术的成年患者。采用事件发生时间分析评估临床结果，采用混合效应模型评估左心室射血分数和主动脉瓣反流分级的变化。技术包括：单纯瓣膜修复（第1组）、升主动脉置换+瓣膜修复（第2组）、部分根部置换±瓣膜修复（第3组）和保留瓣膜根部置换±瓣膜修复（第4组）。
每组10年生存率与匹配的普通人群生存率相当。第1组10年再次干预的累积发生率为19.5%[95%置信区间（CI）16.70 - 22.40%][第1组仅包括双外侧瓣环成形术；不同技术之间再次干预无显著差异（P = 0.112）]；第2组为13.8%（95%CI 10.10 - 18.10%）；第3组为12.7%（95%CI 5.50 - 22.90%）；第4组为8.5%（95%CI 7.00 - 10.10%）（P < 0.001）。术前严重主动脉瓣反流分级[风险比1.95（95%CI 1.19 - 3.21），P < 0.001]和左心室舒张末期直径[风险比1.03（95%CI 1.00 - 1.05），P < 0.001]是第4组再次干预的预测因素；所有组中补片的使用都是一个预测因素。预测的左心室射血分数（%）最初升高（P < 0.001），然后稳定。
本研究发现，主动脉瓣修复/保留技术提供了可行且有效的治疗选择，对于所有符合条件的主动脉瓣反流和/或主动脉根部/升主动脉瘤患者都应予以考虑，因为这些技术有可能恢复预期寿命，并在可接受的再次干预风险下提供良好的血流动力学结果。
