Impact of positional relationship of commissures on cusp function after valve-sparing root replacement for regurgitant bicuspid aortic valve
Impact of positional relationship of commissures on cusp function after valve-sparing root replacement for regurgitant bicuspid aortic valve
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DOI：
10.1093/ejcts/ezv438
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发表时间：
2016-07-01
影响因子：
3.4
通讯作者：
Okita, Yutaka
中科院分区：
文献类型：
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作者：
Miyahara, Shunsuke;Abe, Noriyuki;Okita, Yutaka
目的：从跨瓣压差(TVPG)和主动脉瓣返流程度两个方面探讨二尖瓣根部置换术后纵向瓣膜功能的变化。方法：在这项非随机化的回顾性研究中，我们选择了两种不同的方法来校正Siever I型BAVs根部再植术中连合口的周向方向：(I)180度方位，两个瓣尖占据相同的表面积；(Ii)保留自然连合方向。结果：自然定向组22例，年龄45.1+/-13.6岁，180度组19例，年龄36.6+/-13.7岁，P=0.053。两组患者的术前变量无显著差异。术后及随访超声心动图显示：自然定向组和180度组出院时平均TVPG峰值分别为17.3±6.6和21.7±11.1 mm Hg(P=0.16)，平均分别为10.0±3.7和11.7±6.0 mm Hg(P=0.33)；随访时峰值分别为19.1+/-6.6和22.9+/-10.6 mm Hg(P=0.24)，平均为9.9+/-3.8和13.2+/-7.2 mm Hg(P=0.12)。因此，180度组有升高TVPG的趋势。手术前后连合角的差值与术后峰值和平均TVPG呈正相关(r=0.53，P=0.041，95%可信区间0.029~0.82，峰值r=0.58，P=0.024，95%可信区间0.092~0.84，平均0.092~0.84)。然而，由于TVPG有升高的趋势，因此应注意180度连合位移位的患者。
OBJECTIVES: The aim of this study is to investigate the longitudinal valve function after valve-sparing root replacement in patients with bicuspid aortic valves (BAVs), in terms of both transvalvular pressure gradient (TVPG) and freedom from aortic regurgitation.METHODS: In this non-randomized retrospective study, two different approaches were chosen for correcting the circumferential orientation of commissures during aortic root reimplantation for Sievers type I BAV: (i) 180 degrees orientation, in which both cusps occupy equal surface areas and (ii) preserving native commissural orientation. From 2005 to 2015, 41 consecutive patients with Sievers type I BAV undergoing valve-sparing root replacement were divided into two groups according to the techniques: native orientation group and 180 degrees group.RESULTS: The native orientation group included 22 patients (age, 45.1 +/- 13.6 years) and the 180 degrees group included 19 patients (age, 36.6 +/- 13.7 years; P = 0.053). There was no significant difference in preoperative variables between the two groups. Postoperative and follow-up echocardiography revealed the following: the average TVPG at the time of discharge in the native orientation and the 180 degrees groups was 17.3 +/- 6.6 and 21.7 +/- 11.1 mmHg (P = 0.16), respectively, at peak and 10.0 +/- 3.7 and 11.7 +/- 6.0 mmHg (P = 0.33), respectively, at mean; at follow-up, the corresponding values were 19.1 +/- 6.6 and 22.9 +/- 10.6 mmHg (P = 0.24) at peak and 9.9 +/- 3.8 and 13.2 +/- 7.2 mmHg (P = 0.12) at mean. Thus, there was a trend towards higher TVPG in the 180 degrees group. The difference between the preoperative and postoperative commissural angles was correlated with higher postoperative peak and mean TVPG (r = 0.53, P = 0.041, 95% confidence interval, 0.029-0.82 at peak and r = 0.58, P = 0.024, 95% confidence interval, 0.092-0.84 at mean).CONCLUSIONS: In terms of freedom from aortic regurgitation and valve function, similar outcomes were achieved in both despite different repair techniques used for fixation of commissures during valve-sparing aortic root replacement in BAV. However, attention should be paid to patients with 180 degrees commissural reposition because of a trend towards higher TVPG.