Valve-Sparing Root Replacement Compared With Composite Valve Graft Procedures in Patients With Aortic Root Dilation

详细信息    查看全文

• 作者：Maral Ouzounian ; MD ; PhD ; ^{maral.ouzounian@uhn.ca" class="auth_mail" title="E-mail the corresponding author} ; Vivek Rao ; MD ; PhD ; Cedric Manlhiot ; PhD ; Nachum Abraham ; MSc ; Carolyn David ; RN ; Christopher M. Feindel ; MD ; MSc ; Tirone E. David ; MD
• 关键词：aortic root aneurysms ; outcomes ; surgery
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：25 October 2016
• 年：2016
• 卷：68
• 期：17
• 页码：1838-1847
• 全文大小：1077 K

文摘

Although aortic valve-sparing (AVS) operations are established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms, comparative long-term outcomes are lacking.

Objectives

This study sought to compare the results of patients undergoing AVS procedures with those undergoing CVG operations.

Methods

From 1990 to 2010, a total of 616 patients age <70 years and without aortic stenosis underwent elective aortic root surgery (AVS, n = 253; CVG with a bioprosthesis [bio-CVG], n = 180; CVG with a mechanical prosthesis [m-CVG], n = 183). A propensity score was used as a covariate to adjust for unbalanced variables in group comparisons. Mean age was 46 ± 14 years, 83.3% were male, and mean follow-up was 9.8 ± 5.3 years.

Results

Patients undergoing AVS had higher rates of Marfan syndrome and lower rates of bicuspid aortic valve than those undergoing bio-CVG or m-CVG procedures. In-hospital mortality (0.3%) and stroke rate (1.3%) were similar among groups. After adjusting for clinical covariates, both bio-CVG and m-CVG procedures were associated with increased long-term major adverse valve-related events compared with patients undergoing AVS (hazard ratio [HR]: 3.4, p = 0.005; and HR: 5.2, p < 0.001, respectively). They were also associated with increased cardiac mortality (HR: 7.0, p = 0.001; and HR: 6.4, p = 0.003). Furthermore, bio-CVG procedures were associated with increased risk of reoperations (HR: 6.9; p = 0.003), and m-CVG procedures were associated with increased risk of anticoagulant-related hemorrhage (HR: 5.6; p = 0.008) compared with AVS procedures.

Conclusions

This comparative study showed that AVS procedures were associated with reduced cardiac mortality and valve-related complications when compared with bio-CVG and m-CVG. AVS is the treatment of choice for young patients with aortic root aneurysm and normal or near-normal aortic cusps.