目的:本研究旨在分析使用其他材料进行主动脉瓣修复的结果,并将其结果与不使用心包补片进行瓣尖修复的结果进行比较。
方法:所有16岁以上的连续患者接受了主动脉瓣膜修复术和外环瓣环成形术治疗孤立性主动脉关闭不全,2003年5月至2019年11月的主动脉瓣关闭不全和管状主动脉瘤或主动脉根部动脉瘤纳入一项队列研究.从AVIATOR注册表(AorticValve修复InternATiOnalRegistry)收集和分析数据。使用倾向评分框架分析(治疗加权的逆概率)来比较各组的结果,同时控制混杂因素。
结果:在16年的研究期间,618例患者接受了主动脉瓣修复术。补片组的8年生存率为92%,无补片组的8年生存率为90.2%,没有显着差异[P=0.957治疗加权(IPTW)加权的逆概率]。与无补片组相比,补片组的早期瓣膜相关再手术频率更高(6%vs1%,P<0.001IPTW加权),8年时主动脉瓣相关再介入和结构性瓣膜恶化的自由度在补片组和无补片组之间没有显着差异(93.7%vs94%,P=0.968IPTW加权;99.3%对96.7%,P=0.964IPTW加权)。
结论:尽管观察到早期再干预的比率更高,使用心包补片进行主动脉瓣修复,在使用外部瓣环成形术的标准化方法中,有效接合高度至少为9毫米,与没有心包补片的瓣膜修复相比,与中期主动脉瓣相关的再手术或结构性瓣膜恶化无关。
OBJECTIVE: This study was undertaken to analyse outcomes of aortic valve repair using additional material and compare the results to those of cusp repair without the use of the pericardial patch.
METHODS: All consecutive patients aged over 16 who underwent aortic valve repair with external ring annuloplasty for isolated aortic insufficiency, aortic insufficiency and tubular aortic aneurysm or aortic root aneurysm between May 2003 and November 2019 were included in a cohort study. Data were collected and analysed from the AVIATOR registry (AorticValve repair InternATiOnal Registry). Propensity score framework analysis (inverse probability of treatment weighting) was used to compare outcomes of the groups while controlling for confounders.
RESULTS: During the 16-year study period, 618 patients underwent aortic valve repair. Eight-year survival rate was 92% in the patch group and 90.2% in the no patch group without significant differences [P = 0.957 inverse probability of treatment weighting (IPTW) weighted]. Early valve-related reoperation was more frequent in the patch group as compared to the no patch group (6% vs 1%, P < 0.001 IPTW weighted), the freedom from aortic valve-related reintervention and from structural valve deterioration at 8 years was not significantly different between the patch and no patch groups (93.7% vs 94%, P = 0.968 IPTW weighted; and 99.3% vs 96.7%, P = 0.964 IPTW weighted).
CONCLUSIONS: Although a higher rate of early reintervention was observed, aortic valve repair using the pericardial patch, in a standardized approach using external annuloplasty, with effective coaptation height of at least 9 mm, was not associated with an increase in mid-term aortic valve-related reoperation or structural valve deterioration as compared to valve repair without the pericardial patch.