Abstract

 

OBJECTIVES

The aim of this study was to evaluate the impact of concomitant ascending aortic replacement on operative morbidity and mortality in patients undergoing aortic valve replacement (AVR).

METHODS

We retrospectively analysed our institutional database for all patients undergoing elective isolated AVR and AVR with concomitant replacement of the ascending aorta between January 2009 and May 2020. Patients undergoing surgery for infective endocarditis or requiring hypothermic circulatory arrest were excluded. A 3:1 propensity matching was performed for 688 patients to compare isolated AVR (120 patients) with AVR + ascending aortic replacement (40 patients).

RESULTS

There were significant differences in median cardiopulmonary bypass (CPB) time [92.5 (75–114) vs 118.5 (104–131) min; P < 0.001], median aortic cross-clamp time [65.0 (51.5–78.5) vs 84.5 (77–94) min; P < 0.001] and median intensive care unit stay [1 (1–3) vs 2 (1–6) days; P < 0.01]. There was no significant difference in the use of intraoperative and postoperative blood products, re-exploration for bleeding, postoperative atrial fibrillation, acute renal failure, incidence of stroke, perioperative myocardial infarction and 30-day mortality.

CONCLUSIONS

Concomitant replacement of the ascending aorta significantly prolongs CPB and aortic clamp times but does not increase operative morbidity and mortality. Therefore, replacement of a dilated ascending aorta appears to be the most durable and safest treatment option in patients undergoing AVR with an aneurysmatic ascending aorta.

中文翻译：

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接受主动脉瓣置换术的患者同时进行升主动脉置换术对手术发病率和死亡率的影响

摘要

 

目标

本研究的目的是评估伴随升主动脉置换术对接受主动脉瓣置换术 (AVR) 患者的手术发病率和死亡率的影响。

方法

我们对 2009 年 1 月至 2020 年 5 月期间接受选择性孤立性 AVR 和 AVR 并同时更换升主动脉的所有患者的机构数据库进行了回顾性分析。排除了因感染性心内膜炎接受手术或需要低温停循环的患者。对 688 名患者进行了 3:1 的倾向匹配，以比较孤立的 AVR（120 名患者）与 AVR + 升主动脉置换术（40 名患者）。

结果

中位体外循环 (CPB) 时间存在显着差异 [92.5 (75–114) 与 118.5 (104–131) 分钟；P  < 0.001]，中位主动脉交叉钳夹时间 [65.0 (51.5–78.5) vs 84.5 (77–94) min；P  < 0.001] 和中位重症监护病房停留时间 [1 (1-3) vs 2 (1-6) 天；P  < 0.01]。术中和术后血制品使用、再次探查出血、术后房颤、急性肾功能衰竭、卒中发生率、围手术期心肌梗死和30天死亡率无显着差异。

结论

升主动脉置换术显着延长 CPB 和主动脉钳夹时间，但不会增加手术发病率和死亡率。因此，对于有动脉瘤性升主动脉的 AVR 患者，更换扩张的升主动脉似乎是最持久和最安全的治疗选择。