Norton Elizabeth L, Wang Yanhua, Patel Parth M, Levine Dov, Binongo Jose, Leshnower Bradley G, Takayama Hiroo, Chen Edward P
Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Ga.
JTCVS Open. 2025 Mar 14;25:10-22. doi: 10.1016/j.xjon.2025.02.020. eCollection 2025 Jun.
Valve-sparing root replacement (VSRR) is associated with excellent short- and long-term outcomes. Although typically offered in young patients, VSRR is performed over a wide age range, including into the eighth decade of life. This study analyzed the influence of age and preoperative comorbidities on operative outcomes, reoperation, and survival following VSRR.
From 2004 to 2021, 780 patients underwent VSRR in an academic database. VSRR was performed using the David V reimplantation technique. A discriminating age cutoff for the effect of age on long-term survival was determined by Contal and O'Quigley methods and patients were divided into 2 groups based on age at time of surgery.
The optimal age cutoff for patients undergoing VSRR was found to be 65 years; 16% were aged 65 years or older at time of surgery. Overall, in-hospital mortality was 1.5% and was significantly higher among the group of patients older than age 65 years (4.1% vs 1.1%; = .03). The cumulative incidence of reoperation of the aortic valve or proximal aorta was similar between the group of patients aged 65 years and older and patients younger than age 65 years (5% vs 6%; = .28). Overall, 10-year survival was 89% and significantly worse among the patients aged 65 years and older (76% vs 92%; < .0001). Age 65 years and older was an independent risk factor for late mortality (hazard ratio, 1.04; 95% CI, 1.01-1.07; = .003).
VSRR can be performed with low operative mortality and excellent freedom from reoperation across age groups. In patients aged 65 years and older, serious consideration should be given when deciding on VSRR, especially in the setting of aortic dissection.
保留瓣膜的根部置换术（VSRR）具有出色的短期和长期疗效。尽管VSRR通常适用于年轻患者，但该手术在广泛的年龄范围内开展，包括八十多岁的患者。本研究分析了年龄和术前合并症对VSRR术后手术结局、再次手术和生存情况的影响。
2004年至2021年期间，学术数据库中有780例患者接受了VSRR。采用David V再植入技术进行VSRR。通过Contal和O'Quigley方法确定年龄对长期生存影响的区分年龄界限，并根据手术时的年龄将患者分为两组。
发现接受VSRR患者的最佳年龄界限为65岁；16%的患者手术时年龄在65岁及以上。总体而言，住院死亡率为1.5%，65岁以上患者组的死亡率显著更高（4.1%对1.1%；P = 0.03）。65岁及以上患者组与65岁以下患者组之间主动脉瓣或主动脉近端再次手术的累积发生率相似（5%对6%；P = 0.28）。总体而言，10年生存率为89%，65岁及以上患者的生存率显著更低（76%对92%；P < 0.0001）。65岁及以上是晚期死亡的独立危险因素（风险比，1.04；95%置信区间，1.01 - 1.07；P = 0.003）。
VSRR手术死亡率低，各年龄组再次手术率低。对于65岁及以上的患者，决定是否进行VSRR时应慎重考虑，尤其是在主动脉夹层的情况下。
