Outcomes of valve-sparing surgery in heritable aortic disorders: results from the AVIATOR registry
Outcomes of valve-sparing surgery in heritable aortic disorders: results from the AVIATOR registry
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DOI：
10.1093/ejcts/ezac366
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发表时间：
2022-08-03
影响因子：
3.4
通讯作者：
El-Hamamsy, Ismail
中科院分区：
文献类型：
--
作者：
Chauvette, Vincent;Kluin, Jolanda;El-Hamamsy, Ismail
目的：根部再植一直是遗传性主动脉疾病患者需要瓣膜保留根部置换术的首选方法。在过去的几年里，在普通人群中，牙根环状成形术已成为牙根再植的替代方法。这项研究的目的是评估遗传性主动脉疾病患者接受瓣膜根部置换术的远期结果，并比较不同的技术。方法：使用飞行员登记表(主动脉瓣关闭不全和升主动脉瘤国际登记处)，数据来自北美和欧洲的5个中心。根据保留瓣膜技术将患者分为4组(根管再植、牙根环状成形术、牙根缝合成形术和单纯根管成形术)。主要终点是无主动脉瓣返流(AR)和无再干预主动脉瓣。次要终点为存活率和瓣环大小随时间的变化。结果：共有237例患者纳入研究(再植100例，重塑+环状成形术76例，重塑+缝合成形术34例，单纯重塑27例)。大多数患者患有马凡综合征(83%)。41%的患者术前AR>；=2。手术死亡率0.4%(n=1)。两种术式在术后AR>；=2(P=0.58)、再干预(P=0.52)和生存期(P=0.59)方面差异无统计学意义。主动脉环大小的变化在10年时有显著差异(P<；0.05)，术后4年开始出现差异。结论：总的来说，瓣膜根部置换术对于遗传性主动脉疾病患者是一种安全、持久的手术。然而，单独的牙根重塑与晚期的环状扩张有关。然而，与再植相比，增加环状成形术可以获得类似的AR、再干预、存活率和环状大小的变化。
OBJECTIVES: Root reimplantation has been the favoured approach for patients with heritable aortic disorder requiring valve-sparring root replacement. In the past few years, root remodelling with annuloplasty has emerged as an alternative to root reimplantation in the general population. The aim of this study was to examine the late outcomes of patients with heritable aortic disorder undergoing valve-sparring root replacement and compare different techniques.METHODS: Using the AVIATOR registry (Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry), data were collected from 5 North American and European centres. Patients were divided into 4 groups according to the technique of valve-sparing used (root reimplantation, root remodelling with ring annuloplasty, root remodelling with suture annuloplasty and root remodelling alone). The primary endpoints were freedom from aortic regurgitation (AR) >= 2 and freedom from reintervention on the aortic valve. Secondary endpoints were survival and changes in annular dimensions over time.RESULTS: A total of 237 patients were included in the study (reimplantation = 100, remodelling + ring annuloplasty = 76, remodelling + suture annuloplasty = 34, remodelling alone = 27). The majority of patients had Marfan syndrome (83%). Preoperative AR >= 2 was present in 41% of the patients. Operative mortality was 0.4% (n = 1). No differences were found between techniques in terms of postoperative AR >= 2 (P = 0.58), reintervention (P = 0.52) and survival (P = 0.59). Changes in aortic annulus dimension were significantly different at 10 years (P < 0.05), a difference that started to emerge 4 years after surgery.CONCLUSIONS: Overall, valve-sparring root replacement is a safe and durable procedure in patients with heritable aortic disorder. Nevertheless, root remodelling alone is associated with late annular dilatation. The addition of an annuloplasty, however, results in similar freedom from AR, reintervention, survival and changes in annulus size compared to reimplantation.