Effect of ascending aorta replacement on the long-term outcomes of bicuspid aortic valve repair

被引：1

作者：

Svensson, Lars G. ^{[1
,3
,6
]}

Rosinski, Brad F. ^{[1
,4
]}

Miletic, Kyle ^{[1
,4
]}

Hodges, Kevin ^{[4
]}

Rajeswaran, Jeevanantham ^{[5
]}

Griffin, Brian ^{[3
]}

Desai, Milind Y. ^{[2
,3
]}

Kalahasti, Vidyasagar ^{[3
]}

Goff, Zackary ^{[4
]}

Johnston, Douglas R. ^{[1
,3
]}

Vargo, Patrick R. ^{[1
,3
]}

Roselli, Eric E. ^{[1
,3
]}

Blackstone, Eugene H. ^{[1
]}

机构：

[1] Cleveland Clin, Lerner Res Inst, Dept Thorac & Cardiovasc Surg, Cleveland, OH USA

[2] Cleveland Clin, Lerner Res Inst, Cardiovasc Med Heart Vasc & Thorac Inst, Cleveland, OH USA

[3] Cleveland Clin, Lerner Res Inst, Aorta Ctr, Cleveland, OH USA

[4] Cleveland Clin, Lerner Res Inst, Educ Inst, Cleveland, OH USA

[5] Cleveland Clin, Lerner Res Inst, Dept Quantitat Hlth Sci, Cleveland, OH USA

[6] Cleveland Clin, Heart Vasc & Thorac Inst, 9500 Euclid Ave,Desk J1-227, Cleveland, OH 44195 USA

来源：

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY | 2023年 / 166卷 / 06期

关键词：

aneurysm; aortic valve regurgitation; connec-tive tissue disorder; reoperation; survival; REIMPLANTATION; DURABILITY; DECOMPOSITION;

D O I：

10.1016/j.jtcvs.2023.02.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: The study objective was to determine the effect of sinutubular junction stabilization on long-term outcomes of bicuspid aortic valve repair.Methods: From January 1998 to January 2020, 419 patients underwent bicuspid aortic valve repair with ascending aorta replacement and 421 without (bicuspid aortic valve repair alone). Propensity score matching (97 pairs) was used to compare outcomes. Results: Before matching, prevalence of severe aortic regurgitation at 10 years was 5.4% after bicuspid aortic valve repair + ascending aorta replacement and 10% after bicuspid aortic valve repair alone; aortic valve gradient was 20 mm Hg after bicuspid aortic valve repair + ascending aorta replacement and 19 mm Hg after bicuspid aortic valve repair alone. Ten-year freedom from reoperation overall was 79% after bicuspid aortic valve repair + ascending aorta replacement and 75% after bicuspid aortic valve repair alone; freedom from late aortic regurgitation was 93% after bicuspid aortic valve repair + ascending aorta replacement and 92% after bicuspid aortic valve repair alone; and freedom from aortic stenosis was 87% after bicuspid aortic valve repair + ascending aorta replacement and 93% after bicuspid aortic valve repair alone. Ten-year survival was 95% after bicuspid aortic valve repair + ascending aorta replacement and 96% after bicuspid aortic valve repair alone. After matching, prevalence of severe aortic regurgitation at 10 years was 11% after bicuspid aortic valve repair + ascending aorta replacement and 9.1% after bicuspid aortic valve repair alone (P = .33); aortic valve gradient was 16 mm Hg after bicuspid aortic valve repair + ascending aorta replacement and 25 mm Hg after bicuspid aortic valve repair alone (P<.0001). Ten-year freedom from reoperation was 85% after bicuspid aortic valve repair + ascending aorta replacement and 72% after bicuspid aortic valve repair alone (P = .08) overall. Ten-year freedom from reoperation for late aortic regurgitation was 88% after bicuspid aortic valve repair + ascending aorta replacement and 86% after bicuspid aortic valve repair alone (P = .65). Freedom from aortic stenosis was 97% after bicuspid aortic valve repair + ascending aorta replacement and 91% after bicuspid aortic valve repair alone (P = .03). Ten-year survival was 96% after bicuspid aortic valve repair + ascending aorta replacement and 96% after bicuspid aortic valve repair alone (P = .16).Conclusions: Bicuspid aortic valve repair with or without ascending aorta replacement is associated with good short-and long-term outcomes. Bicuspid aortic valve repair + ascending aorta replacement has a minimal effect on long-term repair durability. Sinutubular junction stabilization should not be performed for the sole purpose of long-term repair durability.

引用

页数：19

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