Abstract：
BACKGROUND: Optimal management of moderate aortic stenosis during surgery for another indication is unclear. We assessed the effects of surgical aortic valve replacement for moderate aortic stenosis during mitral surgery.
METHODS: An institutional mitral surgery database was queried for patients with preoperative moderate aortic stenosis. Patients were stratified by whether they underwent concomitant surgical aortic valve replacement. Morbidity was analyzed using Student\'s t tests, Wilcoxon rank sum, chi-squared, and Fisher\'s exact tests. Survival was analyzed using Kaplan-Meier estimation and Cox regression.
RESULTS: Of 85 mitral surgery recipients with moderate aortic stenosis from 2012 to 2019, 62 (73%) underwent concomitant surgical aortic valve replacement. Surgical aortic valve replacement recipients were more likely to have bicuspid (11% vs. 0%, p = 0.019) or rheumatic (18% vs. 0%, p = 0.019) aortic valves, and to undergo mitral repair (32% vs. 9%, p = 0.028). Groups did not differ with respect to mitral etiology, New York Heart Association class, or cardiac intervention history (p > 0.05). Postoperatively, groups had similar stroke and gastrointestinal bleed rates (3% vs. 0% and 2% vs. 0% in the surgical aortic valve replacement vs. no surgical aortic valve replacement group respectively, both p > 0.99). Five-year survival free from severe aortic stenosis was higher in the surgical aortic valve replacement group (66% vs. 17%, p = 0.002). Surgical aortic valve replacement protected against the composite of death and progression to severe aortic stenosis at 5 years (hazard ratio: 0.32, p = 0.003).
CONCLUSIONS: Surgical aortic valve replacement for moderate aortic stenosis at time of mitral surgery is a well-tolerated strategy to reduce aortic disease progression.
METHODS: An institutional mitral surgery database was queried for patients with preoperative moderate aortic stenosis. Patients were stratified by whether they underwent concomitant surgical aortic valve replacement. Morbidity was analyzed using Student\'s t tests, Wilcoxon rank sum, chi-squared, and Fisher\'s exact tests. Survival was analyzed using Kaplan-Meier estimation and Cox regression.
RESULTS: Of 85 mitral surgery recipients with moderate aortic stenosis from 2012 to 2019, 62 (73%) underwent concomitant surgical aortic valve replacement. Surgical aortic valve replacement recipients were more likely to have bicuspid (11% vs. 0%, p = 0.019) or rheumatic (18% vs. 0%, p = 0.019) aortic valves, and to undergo mitral repair (32% vs. 9%, p = 0.028). Groups did not differ with respect to mitral etiology, New York Heart Association class, or cardiac intervention history (p > 0.05). Postoperatively, groups had similar stroke and gastrointestinal bleed rates (3% vs. 0% and 2% vs. 0% in the surgical aortic valve replacement vs. no surgical aortic valve replacement group respectively, both p > 0.99). Five-year survival free from severe aortic stenosis was higher in the surgical aortic valve replacement group (66% vs. 17%, p = 0.002). Surgical aortic valve replacement protected against the composite of death and progression to severe aortic stenosis at 5 years (hazard ratio: 0.32, p = 0.003).
CONCLUSIONS: Surgical aortic valve replacement for moderate aortic stenosis at time of mitral surgery is a well-tolerated strategy to reduce aortic disease progression.
摘要：
背景：术中中度主动脉瓣狭窄的另一种适应症的最佳管理尚不清楚。我们评估了二尖瓣手术中外科主动脉瓣置换术对中度主动脉瓣狭窄的影响。
方法：查询机构二尖瓣手术数据库中的术前中度主动脉瓣狭窄患者。根据患者是否同时接受外科主动脉瓣置换术进行分层。发病率使用学生t检验进行分析，威尔科克森等级总和，卡方，和费希尔的精确测试。使用Kaplan-Meier估计和Cox回归分析生存率。
结果：在2012年至2019年的85例中度主动脉瓣狭窄的二尖瓣手术受者中，有62例（73％）接受了外科主动脉瓣置换术。手术主动脉瓣置换受者更可能患有二尖瓣（11％vs.0%,p=0.019)或风湿病(18%vs.0%,p=0.019)主动脉瓣,并接受二尖瓣修复(32%vs.9%,p=0.028)。各组在二尖瓣病因方面没有差异，纽约心脏协会班,或心脏介入治疗史(p>0.05)。术后,两组的卒中和胃肠道出血率相似(3%vs.0%和2%vs.0％在外科主动脉瓣置换术中与分别为无手术主动脉瓣置换术组,两者p>0.99)。外科主动脉瓣置换术组无严重主动脉瓣狭窄的五年生存率较高(66%vs.17%,p=0.002)。手术主动脉瓣置换术可防止死亡和进展至5年严重主动脉瓣狭窄的复合（风险比：0.32，p=0.003）。
结论：手术主动脉瓣置换术治疗二尖瓣手术时的中度主动脉瓣狭窄是减少主动脉疾病进展的良好耐受性策略。
方法：查询机构二尖瓣手术数据库中的术前中度主动脉瓣狭窄患者。根据患者是否同时接受外科主动脉瓣置换术进行分层。发病率使用学生t检验进行分析，威尔科克森等级总和，卡方，和费希尔的精确测试。使用Kaplan-Meier估计和Cox回归分析生存率。
结果：在2012年至2019年的85例中度主动脉瓣狭窄的二尖瓣手术受者中，有62例（73％）接受了外科主动脉瓣置换术。手术主动脉瓣置换受者更可能患有二尖瓣（11％vs.0%,p=0.019)或风湿病(18%vs.0%,p=0.019)主动脉瓣,并接受二尖瓣修复(32%vs.9%,p=0.028)。各组在二尖瓣病因方面没有差异，纽约心脏协会班,或心脏介入治疗史(p>0.05)。术后,两组的卒中和胃肠道出血率相似(3%vs.0%和2%vs.0％在外科主动脉瓣置换术中与分别为无手术主动脉瓣置换术组,两者p>0.99)。外科主动脉瓣置换术组无严重主动脉瓣狭窄的五年生存率较高(66%vs.17%,p=0.002)。手术主动脉瓣置换术可防止死亡和进展至5年严重主动脉瓣狭窄的复合（风险比：0.32，p=0.003）。
结论：手术主动脉瓣置换术治疗二尖瓣手术时的中度主动脉瓣狭窄是减少主动脉疾病进展的良好耐受性策略。
