Reoperative aortic root replacement in patients with previous aortic surgery
Reoperative aortic root replacement in patients with previous aortic surgery
复制标题
DOI：
10.1016/j.athoracsur.2007.05.049
复制
发表时间：
2007-11-01
影响因子：
4.6
通讯作者：
Pochettino, Alberto
中科院分区：
文献类型：
--
作者：
Szeto, Wilson Y.;Bavaria, Joseph E.;Pochettino, Alberto
背景资料。再次手术的主动脉根部重建术越来越多，仍然是临床上的一个挑战。本研究的目的是评估以往主动脉手术后再次行主动脉根部置换术患者的预后。自1995~2006年间，156例患者接受了再次手术的主动脉根部置换术，其中主动脉瓣置换术(组1，n=106，67.8%)、近端主动脉瓣重建术(组2，n=25，16.1%)和主动脉根部置换术(组3，n=25，16.1%)。对他们的病历进行了回顾。平均年龄58.1±14.4岁，其中男性占73.7%(n=115)。再次手术在再次手术后98.4个月，其中14.7%(n=23)进行了3次或3次以上的胸骨切开手术。再次手术指征：心内膜炎55例(35.3%)，人工瓣膜功能不全28例(17.9%)，瓣膜旁漏12例(7.7%)，主动脉瘤或假性动脉瘤29例(18.5%)，主动脉夹层12例(7.7%)，主动脉瓣狭窄或关闭不全20例(12.9%)。156例患者均行主动脉根部置换术，同期行半弓重建62例(39.7%)，Cabrol冠状动脉重建5例(3.2%)，冠状动脉旁路移植术(CABG)26例(16.6%)，二尖瓣修复术(MVR)25例(16.0%)。术后30d死亡率为11.5%(n=18)。1年生存率为86.4%+/-2.7%，5年72.6%+/-4.3%，10年58.4%+/-7.8%。亚组分析显示三组间30d死亡率(组1，14.1%；组2，8.0%；组3，4.0%；p=0.31)和晚期存活率无差异(p=0.14)。多变量分析显示年龄大于75岁(p=0.03)和纽约心脏协会(NYHA)功能IV级(p=0.05)是30天死亡率的危险因素。再手术行主动脉根部重建术可获得较低的围手术期死亡率和满意的长期存活率。年龄超过75岁和NYHA IV级是早期死亡的危险因素。既往的主动脉根部置换术不是再次手术的危险因素。
Background. Reoperative aortic root reconstruction is increasingly performed and remains a clinical challenge. The aim of this study is to evaluate the outcome of patients undergoing reoperative aortic root replacement after previous aortic surgery.Methods. From 1995 to 2006, 156 consecutive patients underwent reoperative aortic root replacement after previous aortic valve replacement (group 1, n = 106, 67.8%), proximal aortic reconstruction (group 2, n = 25, 16.1%), and aortic root replacement (group 3, n = 25, 16.1%). Their records were retrospectively reviewed.Results. The mean age was 58.1 +/- 14.4 years, and 73.7% (n = 115) were men. Reoperation was performed 98.4 months after previous operation, with 14.7% (n = 23) having undergone three or more sternotomies. Indications for reoperations were endocarditis in 55 (35.3%), prosthetic valve dysfunction in 28 (17.9%), paravalvular leak in 12 (7.7%), aortic aneurysm or pseudoaneurysm in 29 (18.5%), aortic dissection in 12 (7.7%), and aortic stenosis or insufficiency in 20 (12.9%). Aortic root replacement was performed in all 156 patients, with concomitant hemiarch reconstruction in 62 (39.7%), Cabrol coronary reconstruction in 5 (3.2%), coronary artery bypass grafting (CABG) in 26 (16.6%), and mitral valve repair or replacement (MVR) in 25 (16.0%). Thirty-day mortality was 11.5% (n = 18). Actuarial survival was 86.4% +/- 2.7% at 1 year, 72.6% +/- 4.3% at 5 years, and 58.4% +/- 7.8% at 10 years. Subgroup analysis demonstrated no difference in 30-day mortality (group 1, 14.1%; group 2, 8.0%; group 3, 4.0%; p = 0.31) and late survival between the three groups (p = 0.14). Multivariate analysis demonstrated age older than 75 years (p = 0.03) and New York Heart Association (NYHA) functional class IV (p = 0.05) as risk factors for 30-day mortality.Conclusions. Reoperative aortic root reconstruction can be performed with a low perioperative mortality rate and satisfactory long-term survival. Age older than 75 years and NYHA class IV are risk factors for early mortality. Previous aortic root replacement is not a risk factor for reoperative aortic root reconstruction.