Yun Sangil, Kim Kyung Hwan, Sohn Suk Ho, Chung Yongwoo, Kang Yoonjin, Kim Ji Seong, Choi Jae Woong
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Thorac Dis. 2025 Apr 30;17(4):2078-2090. doi: 10.21037/jtd-24-1739. Epub 2025 Apr 28.
Aortic valve replacement (AVR) frequently accompanies concomitant ascending aorta replacement. This study was conducted to evaluate the early and midterm outcomes of patients who underwent AVR with rapid-deployment valve (RDAVR) and concomitant ascending aorta replacement compared to those who underwent isolated RDAVR.
From June 2016 to June 2023, 130 patients who underwent RDAVR with concomitant ascending aorta replacement (Ao-AVR group) and 108 patients who underwent isolated RDAVR (Iso-AVR group) were enrolled in this study. Early and midterm outcomes were compared between the groups. Multivariate analysis was performed to identify the risk factors associated with all-cause mortality.
Ao-AVR group was younger and less morbid than Iso-AVR group. Bicuspid aortic valvulopathy was the main etiology in Ao-AVR group (71.5%), whereas degenerative calcific valvulopathy was the main etiology in Iso-AVR group (55.6%). Cardiopulmonary bypass time and aortic cross-clamp time were 21 and 28 minutes longer, respectively, in Ao-AVR group. Operative mortality was 0.0% in Ao-AVR group, and their early clinical outcomes were comparable to those of Iso-AVR group, except for the occurrence of postoperative atrial fibrillation (46.9% 34.3%, P=0.048). Multivariate analysis demonstrated that age, chronic obstructive pulmonary disease, and emergency operation were the significant risk factors associated with midterm all-cause mortality, whereas concomitant ascending aorta replacement was not a risk factor.
Concomitant ascending aorta replacement during RDAVR demonstrated excellent early and midterm outcomes, comparable to isolated RDAVR.
主动脉瓣置换术（AVR）常伴有升主动脉置换术。本研究旨在评估接受快速部署瓣膜主动脉瓣置换术（RDAVR）并同时进行升主动脉置换术的患者与接受单纯RDAVR的患者的早期和中期结果。
2016年6月至2023年6月，本研究纳入了130例接受RDAVR并同时进行升主动脉置换术的患者（主动脉-AVR组）和108例接受单纯RDAVR的患者（单纯AVR组）。比较两组的早期和中期结果。进行多因素分析以确定与全因死亡率相关的危险因素。
主动脉-AVR组比单纯AVR组更年轻且病情较轻。主动脉瓣二叶式病变是主动脉-AVR组的主要病因（71.5%），而退行性钙化性瓣膜病是单纯AVR组的主要病因（55.6%）。主动脉-AVR组的体外循环时间和主动脉阻断时间分别长21分钟和28分钟。主动脉-AVR组的手术死亡率为0.0%，除术后房颤发生率外（46.9%对34.3%，P=0.048），其早期临床结果与单纯AVR组相当。多因素分析表明，年龄、慢性阻塞性肺疾病和急诊手术是与中期全因死亡率相关的重要危险因素，而同时进行升主动脉置换术不是危险因素。
RDAVR期间同时进行升主动脉置换术显示出优异 的早期和中期结果，与单纯RDAVR相当。
