Non-aneurysmal ascending aorta diameter changes after aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve
Non-aneurysmal ascending aorta diameter changes after aortic valve replacement in patients with stenotic bicuspid and tricuspid aortic valve
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DOI：
10.1007/s11748-021-01669-3
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发表时间：
2021-06-11
影响因子：
1.2
通讯作者：
Takahashi, Shinya
中科院分区：
文献类型：
--
作者：
Hiraoka, Toshifumi;Furukawa, Tomokuni;Takahashi, Shinya
目的二叶式主动脉瓣相关性心脏病患者主动脉瓣修复术的合适时机仍存在争议。我们描述了二叶或三叶主动脉瓣狭窄的主动脉瓣置换术后非动脉瘤性升主动脉直径的变化。方法回顾性分析2008年1月至2018年12月期间189例因升主动脉直径≤ 45 mm的非狭窄性主动脉瓣重度狭窄行主动脉瓣置换术的患者。采用线性混合效应模型分析比较二叶和三叶主动脉瓣患者主动脉瓣置换术后升主动脉管状部非囊状扩张率。结果二叶式主动脉瓣组主动脉瓣扩张率明显高于三叶式主动脉瓣组（0.36 mm/年vs.0.09 mm/年，p < 0.001）。二叶式主动脉瓣的具体形式也影响主动脉直径扩大：0型（根据Sievers分类）组的0.85 mm/年扩大率约为非0型组的5倍（p < 0.001）。在二叶或三叶主动脉瓣组中，未观察到主动脉事件，并且没有患者需要对升主动脉进行再次手术。结论二叶式主动脉瓣狭窄主动脉瓣置换术后升主动脉持续进行性扩张的可能性，尤其是0型二叶式主动脉瓣患者，需要对升主动脉进行仔细的术后评估。
Objective The appropriate timing of aortic repair in patients with bicuspid aortic valve-related aortopathy remains controversial. We describe the changes in diameter of the non-aneurysmal ascending aorta after aortic valve replacement for bicuspid or tricuspid aortic valve stenosis. Methods This retrospective review included 189 patients who had undergone aortic valve replacement for severe stenotic aortic valve with a non-aneurysmal ascending aorta diameter of 45 mm or less between January 2008 and December 2018. A linear mixed-effect model was used to analyze and compare the enlargement rates of the non-aneurysmal ascending aorta at the tubular portion after aortic valve replacement in bicuspid and tricuspid aortic valve patients. Results The enlargement rate of the non-aneurysmal ascending aorta after aortic valve replacement was significantly greater in the bicuspid aortic valve group than in the tricuspid aortic valve group (0.36 mm/year vs. 0.09 mm/year, p < 0.001). The specific form of bicuspid aortic valve also affected aorta diameter enlargement: the enlargement rate of 0.85 mm/year in the Type 0 (according to Sievers' classification) group was approximately five times that in the Non-Type 0 group (p < 0.001). No aortic events were observed, and no patients needed reoperations for the ascending aorta, in either the bicuspid or tricuspid aortic valve groups. Conclusion The persistent possibility of progressive ascending aortic dilatation after aortic valve replacement for bicuspid aortic valve stenosis, especially in Type 0 bicuspid aortic valve patients, demands careful post-procedural evaluation of the ascending aorta.