无需冠状动脉开口动员或再植的主动脉根部置换替代重塑技术的中期结果,Journal of Cardiothoracic Surgery

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无需冠状动脉开口动员或再植的主动脉根部置换替代重塑技术的中期结果
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-02-01 , DOI: 10.1186/s13019-022-02051-x
Leonidas Hadjinikolaou ₁ , Metesh Acharya ₁ , Carmelo Dominici ₂ , Fausto Biancari ₃ , Furqan Raheel ₁ , Aamer Ahmed ₄ , Giovanni Mariscalco ₁

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我们将改良的主动脉根部重塑 (ARR) 技术用于主动脉根部置换而不动员或再植入冠状动脉开口，与改良的 Bentall-de Bono 手术的早期和晚期结果进行了比较。一项回顾性观察研究纳入了 2013 年 1 月至 2019 年 12 月期间接受改良 Bentall-de Bono 手术（104 名患者）或 ARR（77 名患者）主动脉根置换术的 181 名连续患者。主要终点包括住院死亡率和晚期生存率。次要终点包括术后并发症的发生率和免于晚期再次手术。ARR 手术的交叉钳夹时间更短，心肺旁路时间与改良的 Bentall-de Bono 手术相当。早期术后并发症的发生率在各组之间具有可比性。ARR 的 30 天死亡率在数值上低于改良的 Bentall-de Bono 手术。在超过 7 年的随访中，4 名患者 (3.8%) 在改良 Bentall-de Bono 手术后需要再次主动脉手术，而在 ARR 后则没有。ARR 和改良 Bentall-de Bono 手术后的长期死亡率分别为 17.1% 和 22.7%。改良 Bentall-de Bono 手术后主动脉根部/瓣膜再介入的累积发生率为 3.2%，ARR 后为 0%。当调整其他独立风险因素时，晚期死亡率不受所执行手术的影响，尽管根据年龄调整的竞争风险表明改良的 Bentall-de Bono 手术与主动脉根部/主动脉瓣再次手术的风险增加有关。与改良的 Bentall-de Bono 手术相比，改良的 ARR 技术可减少心肌缺血时间、降低术后死亡率和主动脉再介入率。它可能被认为是一种安全可行的主动脉根部/升主动脉置换术，可提供良好的长期结果。

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Mid-term outcomes of an alternative remodelling technique for aortic root replacement without coronary ostial mobilisation or reimplantation

We compare the early and late outcomes of a modified aortic root remodelling (ARR) technique for aortic root replacement without mobilisation or reimplantation of the coronary ostia, with those of the modified Bentall-de Bono procedure. A retrospective observational study was performed comprising 181 consecutive patients who underwent aortic root replacement with a modified Bentall-de Bono procedure (104 patients) or ARR (77 patients) between January 2013 and December 2019. Primary endpoints included hospital mortality and late survival. Secondary endpoints included incidence of post-operative complications and freedom from late re-operation. ARR procedures were performed with shorter cross-clamp times and comparable cardiopulmonary bypass times to modified Bentall-de Bono procedures. The incidence of early post-complications was comparable between groups. 30-day mortality was numerically lower with ARR than the modified Bentall-de Bono procedure. Over 7-year follow-up, 4 patients (3.8%) required repeat aortic surgery after a modified Bentall-de Bono procedure, and none after ARR. Long-term mortality after ARR and after modified Bentall-de Bono procedures was 17.1% and 22.7%, respectively. The cumulative incidence of reintervention on the aortic root/valve was 3.2% after a modified Bentall-de Bono procedure and 0% after ARR. When adjusted for other independent risk factors, late mortality was not influenced by the procedure performed, although competing risk adjusted for age showed that the modified Bentall-de Bono procedure was associated with an increased risk of aortic root/aortic valve re-operation. The modified ARR technique is associated with reduced myocardial ischaemia time, lower post-operative mortality and aortic re-intervention rates compared to a modified Bentall-de Bono procedure. It may be considered a safe and feasible procedure for aortic root/ascending aortic replacement offering good long-term outcomes.

更新日期：2023-02-01

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