Kari Fabian A, Czerny Martin, Borger Michael, Misfeld Martin, Zimmer Emmanuel, Siepe Matthias, Hagl Christian, Detter Christian, Petersen Johannes, Richardt Doreen, Ensminger Stephan, Werner Paul, Andreas Martin, Pichlmaier Maximilian, Mueller Christoph S
Department of Cardiac Surgery, LMU University Hospital, Munich, Germany.
Congenital and Pediatric Cardiac Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany.
JTCVS Open. 2025 Mar 3;24:85-95. doi: 10.1016/j.xjon.2025.02.015. eCollection 2025 Apr.
The study objective was to identify quantitative criteria to avoid residual aortic valve regurgitation after valve-sparing aortic root replacement.
Between 2016 and 2023, 738 adult patients were recruited into the German Aortic Root Repair Registry. A total of 562 patients with datasets on aortic root measurements and tricuspid valve treated with reimplantation valve-sparing aortic root replacement were selected. End points were any grade of residual aortic valve regurgitation and postrepair coaptation height. Tested variables included procedural and anatomic characteristics, including length of cusp margins and geometric cusp heights.
The optimal classifier predicting freedom from residual aortic valve regurgitation was cusp coaptation height 8 to 9 mm or more (sensitivity = 0.7-0.8). Annular downsizing alone was not useful to predict residual aortic valve regurgitation ( = .472, 95% area CI, 0.414-0.54). Patients with a mean free margin length of at least 45 mm and a sum of free margin lengths of at least 125 mm were more likely to present coaptation heights of at least 10 mm (R2 0.038, = .006).
The target coaptation height after valve-sparing aortic root replacement should exceed 8 to 9 mm. Chances of achieving it can be estimated on the basis of a measurement of cusp quantity. If in doubt when inspecting a valve, numerical criteria can help with surgical decision-making in favor of or against a valve-sparing approach.
本研究的目的是确定在保留瓣膜的主动脉根部置换术后避免残余主动脉瓣反流的定量标准。
2016年至2023年期间，738例成年患者被纳入德国主动脉根部修复注册研究。总共选择了562例有主动脉根部测量数据集且接受了保留瓣膜的主动脉根部再植入置换术治疗的患者。终点为任何级别的残余主动脉瓣反流和修复后的瓣叶对合高度。测试变量包括手术和解剖特征，包括瓣叶边缘长度和几何瓣叶高度。
预测无残余主动脉瓣反流的最佳分类指标是瓣叶对合高度为8至9毫米或更高（敏感性=0.7-0.8）。单纯环缩对预测残余主动脉瓣反流并无帮助（P=0.472，95%面积置信区间，0.414-0.54）。平均游离缘长度至少为45毫米且游离缘长度总和至少为125毫米的患者更有可能出现至少10毫米的对合高度（R2=0.038，P=0.006）。
保留瓣膜的主动脉根部置换术后的目标对合高度应超过8至9毫米。可以根据瓣叶数量的测量来估计实现该目标的可能性。在检查瓣膜时如有疑问，数值标准有助于支持或反对保留瓣膜方法的手术决策。
