Lorenz Veronica, Jahanyar Jama, Mastrobuoni Stefano, Segreto Antonio, Zanella Luca, Aphram Gaby, Pettinari Matteo, El Khoury Gebrine, De Kerchove Laurent
Department of Cardiovascular & Thoracic Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Division of Cardiac Surgery, Inova Schar Heart & Vascular Institute, Inova Fairfax Medical Campus, Falls Church, VA, USA.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 29;40(4). doi: 10.1093/icvts/ivaf067.
Aortic valve-sparing root replacement using the reimplantation technique and mitral valve (MV) repair are well-established surgical approaches for the treatment of aortic root pathologies and mitral valve insufficiency. However, the management of concomitant diseases with a dual valve-preserving strategy remains poorly described. Therefore, the aim of this study is to evaluate the long-term outcomes of concomitant valve-sparing surgery and MV repair.
This case series includes all the patients who underwent combined valve-sparing root replacement and MV repair at Cliniques Universitaires Saint-Luc (Brussels, Belgium) between January 2000 and June 2022. Actual survival rate and freedom from reoperation were calculated by the Kaplan-Meier method, and the log rank test was used for statistical evaluation.
Forty-five patients were included in the study; they were divided into two groups (13 patients with and 32 patients without connective tissue disorders). There was no hospital mortality. Three patients (7%) required pacemaker implantation. Overall survival at 10 years was 90% (95% confidence interval [CI]: 64-97%). Furthermore, freedom from all reoperations at 10 years was 84% (95% CI: 64-93%). Analysing the two subgroups, we found no statistically significant difference in terms of 10-year survival (log rank P = 0.146). However, freedom from reoperation at 10 years was significantly lower in the connective tissue disorder group (63% vs 91%, log rank P = 0.031). Most patients treated with transaortic edge-to-edge repair required MV reoperation.
Combined valve-sparing root replacement with the reimplantation technique and MV operations are complex surgeries. However, they can be performed safely, with excellent long-term survival and repair durability. Applying standard Carpentier techniques for MV repair is crucial, especially in patients with connective tissue disorders.
采用再植入技术保留主动脉瓣的根部置换术和二尖瓣（MV）修复术是治疗主动脉根部病变和二尖瓣关闭不全的成熟手术方法。然而，采用双瓣膜保留策略处理合并疾病的相关情况仍鲜有描述。因此，本研究旨在评估保留瓣膜手术与MV修复联合手术的长期疗效。
本病例系列纳入了2000年1月至2022年6月期间在比利时布鲁塞尔圣吕克大学医院接受保留瓣膜根部置换术与MV修复联合手术的所有患者。采用Kaplan-Meier法计算实际生存率和再次手术自由度，并使用对数秩检验进行统计学评估。
45例患者纳入本研究；他们被分为两组（13例患有结缔组织疾病，32例未患有结缔组织疾病）。无院内死亡。3例患者（7%）需要植入起搏器。10年时的总生存率为90%（95%置信区间[CI]：64-97%）。此外，10年时无需再次手术的自由度为84%（95%CI：64-93%）。分析这两个亚组，我们发现10年生存率无统计学显著差异（对数秩P = 0.146）。然而，结缔组织疾病组10年时再次手术自由度显著更低（63%对91%，对数秩P = 0.031）。大多数接受经主动脉缘对缘修复治疗的患者需要进行MV再次手术。
采用再植入技术保留主动脉瓣的根部置换术与MV手术联合是复杂手术。然而，它们可以安全进行，具有出色的长期生存率和修复耐久性。应用标准的Carpentier技术进行MV修复至关重要，尤其是在患有结缔组织疾病的患者中。
