PDF(Pubmed)
Abstract：
UNASSIGNED: Clinical outcomes of bicuspid aortic valve (BAV) patients with ascending aortic diameters ≥50 mm who are under surveillance are poorly defined.
UNASSIGNED: The purpose of this study was to assess clinical outcomes in BAV patients with ascending aorta ≥50 mm.
UNASSIGNED: Multicenter retrospective cohort study of BAV adults with ascending aorta diameters ≥50 mm by transthoracic echocardiography (TTE). Patients were categorized into 50 to 54 mm and ≥55 mm groups. Clinical outcomes were aortic dissection (AoD), aorta surgery, surgical mortality, and all-cause death.
UNASSIGNED: Of 875 consecutive BAV patients (age 60 ± 13 years, 86% men, aortic diameter 51 mm [interquartile range (IQR): 50-53 mm]), 328 (37%) underwent early surgery ≤3 months from index TTE. Of the remaining 547 patients under surveillance, 496 had diameters 50 to 54 mm and 51 had diameters ≥55 mm and were collectively followed for 7.51 (IQR: 3.98-12.20) years. Of 496 patients with diameters 50 to 54 mm under surveillance, 266 (54%) underwent surgery 2.0 (IQR: 0.77-4.16) years from index TTE. AoD occurred in 9/496 (1.8%) patients for an incidence of 0.4 cases per 100 person-years, surgical mortality was 5/266 (1.9%); and ≥moderate aortic stenosis (but not aorta size) was associated with all-cause death, hazard ratio: 2.05 (95% CI: 1.32-3.20), P = 0.001. Conversely, in 547 total patients under surveillance (including 50-54 mm and ≥55 mm), both aorta size and ≥moderate aortic stenosis were associated with all-cause death (both P ≤ 0.027). AoD rate in patients ≥55 mm under surveillance was 5.9%.
UNASSIGNED: In BAV patients with ascending aorta 50 to 54 mm under surveillance, AoD incidence is low and the overall rates of AoD and surgical mortality are similar, suggesting clinical equivalence between surgical and surveillance strategies. Conversely, patients with aortas ≥55 mm should undergo surgery. Aortic stenosis is associated with all-cause death in these patients.
UNASSIGNED: The purpose of this study was to assess clinical outcomes in BAV patients with ascending aorta ≥50 mm.
UNASSIGNED: Multicenter retrospective cohort study of BAV adults with ascending aorta diameters ≥50 mm by transthoracic echocardiography (TTE). Patients were categorized into 50 to 54 mm and ≥55 mm groups. Clinical outcomes were aortic dissection (AoD), aorta surgery, surgical mortality, and all-cause death.
UNASSIGNED: Of 875 consecutive BAV patients (age 60 ± 13 years, 86% men, aortic diameter 51 mm [interquartile range (IQR): 50-53 mm]), 328 (37%) underwent early surgery ≤3 months from index TTE. Of the remaining 547 patients under surveillance, 496 had diameters 50 to 54 mm and 51 had diameters ≥55 mm and were collectively followed for 7.51 (IQR: 3.98-12.20) years. Of 496 patients with diameters 50 to 54 mm under surveillance, 266 (54%) underwent surgery 2.0 (IQR: 0.77-4.16) years from index TTE. AoD occurred in 9/496 (1.8%) patients for an incidence of 0.4 cases per 100 person-years, surgical mortality was 5/266 (1.9%); and ≥moderate aortic stenosis (but not aorta size) was associated with all-cause death, hazard ratio: 2.05 (95% CI: 1.32-3.20), P = 0.001. Conversely, in 547 total patients under surveillance (including 50-54 mm and ≥55 mm), both aorta size and ≥moderate aortic stenosis were associated with all-cause death (both P ≤ 0.027). AoD rate in patients ≥55 mm under surveillance was 5.9%.
UNASSIGNED: In BAV patients with ascending aorta 50 to 54 mm under surveillance, AoD incidence is low and the overall rates of AoD and surgical mortality are similar, suggesting clinical equivalence between surgical and surveillance strategies. Conversely, patients with aortas ≥55 mm should undergo surgery. Aortic stenosis is associated with all-cause death in these patients.
摘要：
■升主动脉直径≥50mm的二叶主动脉瓣（BAV）患者在监测中的临床结果定义不明确。
■本研究的目的是评估升主动脉≥50mm的BAV患者的临床结果。
■通过经胸超声心动图（TTE）对升主动脉直径≥50mm的BAV成人进行多中心回顾性队列研究。患者分为50至54毫米和≥55毫米组。临床结果为主动脉夹层（AoD），主动脉手术,手术死亡率,和全因死亡。
■875名连续的BAV患者（年龄60±13岁，86%的男性主动脉直径51毫米[四分位距（IQR）：50-53毫米]），328（37％）从TTE指数开始≤3个月接受了早期手术。在其余的547名患者中，496的直径为50至54mm，51的直径≥55mm，并共同随访7.51（IQR：3.98-12.20）年。在496名直径为50至54毫米的患者中，266（54％）接受手术2.0（IQR：0.77-4.16）年从指数TTE。AoD发生在9/496（1.8％）患者中，发生率为每100人年0.4例，手术死亡率为5/266(1.9%);≥中度主动脉瓣狭窄(而非主动脉大小)与全因死亡相关,危害比：2.05（95%CI：1.32-3.20），P=0.001。相反，在547名接受监测的患者中（包括50-54毫米和≥55毫米），主动脉大小和≥中度主动脉瓣狭窄均与全因死亡相关(均P≤0.027).监测下≥55mm患者的AoD率为5.9%。
■在监视下升主动脉50至54mm的BAV患者中，AoD发病率低，AoD和手术死亡率的总体比率相似，提示手术和监测策略之间的临床等效性。相反，主动脉≥55mm的患者应接受手术治疗.主动脉瓣狭窄与这些患者的全因死亡有关。
■本研究的目的是评估升主动脉≥50mm的BAV患者的临床结果。
■通过经胸超声心动图（TTE）对升主动脉直径≥50mm的BAV成人进行多中心回顾性队列研究。患者分为50至54毫米和≥55毫米组。临床结果为主动脉夹层（AoD），主动脉手术,手术死亡率,和全因死亡。
■875名连续的BAV患者（年龄60±13岁，86%的男性主动脉直径51毫米[四分位距（IQR）：50-53毫米]），328（37％）从TTE指数开始≤3个月接受了早期手术。在其余的547名患者中，496的直径为50至54mm，51的直径≥55mm，并共同随访7.51（IQR：3.98-12.20）年。在496名直径为50至54毫米的患者中，266（54％）接受手术2.0（IQR：0.77-4.16）年从指数TTE。AoD发生在9/496（1.8％）患者中，发生率为每100人年0.4例，手术死亡率为5/266(1.9%);≥中度主动脉瓣狭窄(而非主动脉大小)与全因死亡相关,危害比：2.05（95%CI：1.32-3.20），P=0.001。相反，在547名接受监测的患者中（包括50-54毫米和≥55毫米），主动脉大小和≥中度主动脉瓣狭窄均与全因死亡相关(均P≤0.027).监测下≥55mm患者的AoD率为5.9%。
■在监视下升主动脉50至54mm的BAV患者中，AoD发病率低，AoD和手术死亡率的总体比率相似，提示手术和监测策略之间的临床等效性。相反，主动脉≥55mm的患者应接受手术治疗.主动脉瓣狭窄与这些患者的全因死亡有关。
