Abstract

Objectives

We report the mid-term outcomes of valve-sparing aortic root replacement (VSRR) in a cohort including patients with bicuspid aortic valve (BAV), connective tissue disorder (CTD), aortic dissection (AD), and congenital heart disease (CHD). Design. From 2005 to 2017, 174 patients underwent VSRR with the reimplantation technique. The mean age was 46 ± 14 years. The mean follow-up time was 4.8 ± 2.8 years. The indication for operation was aortic aneurysm for 127 (73%), aortic insufficiency (AI) for 38 (22%), and AD for 9 patients (5%). Preoperatively, 53 patients (31%) had ≥ moderate AI. BAV, CTD (Marfan or Loyes-Dietz), previous Ross procedure, or CHD was present in 57 (33%), 28 (16%), 7 (4%) and 12 patients (7%), respectively. Concomitant aortic valve repair was performed for 103 patients (59%). Results. Thirty-day mortality was zero. Four patients underwent aortic valve replacement (AVR) during follow-up. Kaplan–Meier estimates for survival, freedom from AVR, and freedom from ≥ moderate AI or reoperation were 96, 98, and 97% at 5 years. There was no difference in survival, freedom from AVR, or freedom from ≥ moderate AI or reoperation in patients with and without BAV, CTD, leaflet repair, or preoperative ≥ moderate AI. In Cox regression analysis, BAV, CTD, aortic valve repair, preoperative ≥ moderate AI, or aortic dimension were not risk factors for reoperation or valve dysfunction. Conclusions. Mid-term outcomes of VSRR for patients with diverse indications in terms of survival, reoperation rate, and valve dysfunction rate were excellent in a center with a limited annual volume of VSSR.

中文翻译：

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不同适应症瓣膜保留根置换术的结果

摘要

目标

我们报告了一个队列中保留瓣膜的主动脉根部置换术 (VSRR) 的中期结果，包括二叶式主动脉瓣 (BAV)、结缔组织疾病 (CTD)、主动脉夹层 (AD) 和先天性心脏病 (CHD) . 设计。从 2005 年到 2017 年，174 名患者接受了再植入技术的 VSRR。平均年龄为 46 ± 14 岁。平均随访时间为 4.8 ± 2.8 年。手术指征为主动脉瘤 127 例（73%），主动脉瓣关闭不全（AI）38 例（22%），AD 9 例（5%）。术前，53 名患者 (31%) 有 ≥ 中度 AI。BAV、CTD（Marfan 或 Loyes-Dietz）、先前的 Ross 手术或 CHD 分别出现在 57 (33%)、28 (16%)、7 (4%) 和 12 (7%) 名患者中。103 名患者（59%）同时进行了主动脉瓣修复。结果。三十天死亡率为零。4 名患者在随访期间接受了主动脉瓣置换术 (AVR)。5 年时，Kaplan-Meier 对生存、无 AVR 和无≥中度 AI 或再次手术的估计分别为 96%、98% 和 97%。有和没有 BAV、CTD、瓣叶修复或术前≥中度 AI 的患者在生存、无 AVR 或无≥中度 AI 或再次手术方面没有差异。在 Cox 回归分析中，BAV、CTD、主动脉瓣修复、术前≥中等 AI 或主动脉尺寸不是再次手术或瓣膜功能障碍的危险因素。结论。在一个年 VSSR 量有限的中心，VSRR 对在生存、再手术率和瓣膜功能障碍率方面具有多种适应症的患者的中期结果非常好。