目标:在主动脉根部手术中,保留瓣膜的主动脉根置换术(VSARR)是一种有吸引力的替代方案,可以减轻人工瓣膜固有的风险。然而,对影响其耐久性的变量知之甚少。我们回顾了VSARR后的中长期结果,并描述了影响生存率和瓣膜再干预和功能不全的因素。
方法:对1999年11月至2022年1月在AustinHealth接受VSARR的284名连续患者进行了回顾性研究,墨尔本,澳大利亚,进行了,中位随访时间为6.43±4.83年,但高达22.0年。免于死亡,使用KaplanMeier方法分析主动脉再介入和关闭不全,Cox比例危险模型与精细灰色分析。
结果:干预的中位年龄为60.0岁(IQR48.0-67.0),其中68例(23.9%)患有二叶主动脉瓣(BAV)疾病,27(9.5%)马凡病,119(41.9%)重度主动脉根部扩张(>50mm),和155(54.6%)严重主动脉瓣关闭不全时的干预。30天死亡率为1.8%,5年无死亡率96.0%(95CI92.6-97.8%),10年无死亡率88.2%(95CI81.4-92.6%)。5年时主动脉再介入的自由度为92.2%(95CI87.7-95.2%),10年时为79.8%(95CI71.8-85.8%)。与再干预相关的因素是伴随小叶修复(HR8.13,95CI1.07-61.7)和二尖瓣病变(HR2.23,95CI1.07-4.68),BAV的再干预更可能是由于主动脉瓣狭窄和TAV到主动脉瓣不足(卡方p=0.05)。主动脉瓣关闭不全的自由度为89.1%(95CI83.5-92.9%),5年和10年分别为84.9%(95CI77.8-89.9%)和80.7%(95CI71.0-87.4%)。
结论:VSARR具有出色的长期结果,低死亡率和再干预率。伴随的小叶修复和双叶瓣膜病是与再干预相关的唯一长期因素。
OBJECTIVE: In aortic root surgery, valve-sparing aortic root replacement is an attractive alternative by mitigating the risks inherent to prosthetic valves; however, little is known about the variables that impact its durability. We review our mid- to long-term outcomes after valve-sparing aortic root replacement and describe factors that impact survival and valve reintervention and insufficiency.
METHODS: A retrospective review of 284 consecutive patients undergoing valve-sparing aortic root replacement between November 1999 and January 2022 at Austin Health, Melbourne, Australia, was undertaken, with a median follow-up of 6.43 ± 4.83 years, but up to 22.0 years. Freedom from mortality, aortic reintervention, and insufficiency was analyzed using Kaplan-Meier methods, Cox proportional hazard models, and Fine-Gray analysis.
RESULTS: The median age of patients at intervention was 60.0 years (interquartile range, 48.0-67.0), of whom 68 (23.9%) had bicuspid aortic valve disease, 27 (9.5%) had Marfan syndrome, 119 (41.9%) had severe aortic root dilation (>50 mm), and 155 had (54.6%) severe aortic insufficiency at the time of intervention. The 30-day mortality was 1.8%, with freedom from mortality of 96.0% (95% CI, 92.6-97.8) at 5 years and 88.2% (95% CI, 81.4-92.6) at 10 years. Freedom from aortic reintervention was 92.2% (95% CI, 87.7-95.2) at 5 years and 79.8% (95% CI, 71.8-85.8) at 10 years. Factors associated with reintervention were concomitant leaflet repair (hazard ratio, 8.13, 95% CI, 1.07-61.7) and bicuspid valvulopathy (hazard ratio, 2.23, 95% CI, 1.07-4.68), with reintervention in the bicuspid aortic valve being more likely due to aortic stenosis and in the tricuspid aortic valve due to aortic insufficiency (chi-square P = .05). The freedom from aortic insufficiency was 89.1% (95% CI, 83.5-92.9), 84.9% (95% CI, 77.8-89.9) at 5 and 10 years, respectively, and 80.7% (95% CI, 71.0-87.4).
CONCLUSIONS: Valve-sparing aortic root replacement has excellent long-term outcomes, with low mortality and reintervention rates. Concomitant leaflet repair and bicuspid valve disease are the only long-term factors associated with reintervention.