Surgical Outcomes in Behcet's Disease Patients With Severe Aortic Regurgitation
Surgical Outcomes in Behcet's Disease Patients With Severe Aortic Regurgitation
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DOI：
10.1016/j.athoracsur.2018.08.040
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发表时间：
2019-04-01
影响因子：
4.6
通讯作者：
Choo, Suk Jung
中科院分区：
文献类型：
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作者：
Ghang, Byeongzu;Kim, Joon Bum;Choo, Suk Jung
背景尚未确定白塞病主动脉瓣返流的最佳治疗方法。我们研究了手术技术、假体材料和免疫调节治疗对手术结果的影响。在这项研究中，23例白塞病手术治疗的主动脉瓣返流进行了评估。重大术后事件定义为死亡、主动脉瓣或移植物相关问题、感染性心内膜炎、致残性卒中和主动脉瓣或根部再次手术。外科手术分为单独主动脉瓣置换术、生物假体根部置换术和机械根部置换术。生物牙根置换组包括同种异体牙根置换。共40例手术，其中39例主动脉瓣或根部手术和1例原位心脏移植，均确诊为白塞病。然而，该研究仅审查了40例病例中的35例（排除了4例病历记录不充分的病例和1例心脏移植病例）。11例单纯主动脉瓣置换术中有8例（73%）、12例生物假体根部置换术中有9例（75%）（5例异种移植物和7例同种异体移植物）和12例机械根部置换术中有4例（33%）发生了严重不良事件。多因素分析显示，出院后1个月C反应蛋白水平和手术年龄是术后无事件生存的独立预测因素。机械牙根置换术被认为是导致积极结局的最显著预测因素（风险比，0.147; 95%置信区间，0.028 - 0.766; p = 0.023）。研究结果表明，机械根置换术结合术后低C反应蛋白水平通过连续免疫调节治疗可能会导致最佳的手术结果与严重主动脉瓣反流相关的白塞病。(C)2019年美国胸外科医师协会
Background. An optimal treatment for aortic regurgitation in Behcet's disease has not been established. We investigated the effect of operative technique, prosthetic material, and immunomodulation therapy on surgical outcomes.Methods. In this study, 23 patients with Behcet's disease surgically treated for aortic regurgitation were assessed. Significant postoperative events were defined as death, aortic valve or graft-related problem(s), infective endocarditis, disabling stroke, and aortic valve or root reoperation. Surgical procedures were classified as isolated aortic valve replacement, bioprosthetic root replacement, and mechanical root replacement. Allograft root replacements were included in the bioprosthetic root replacement group.Results. A total of 40 operations, including 39 aortic valve or root surgeries and 1 orthotopic heart transplantation, were performed on patients confirmed with Behcet's disease. However, the study only reviewed 35 of the 40 cases (4 cases with inadequately documented medical records and 1 heart transplantation case were excluded). Significant adverse events occurred in 8 of 11 (73%) isolated aortic valve replacement, 9 of 12 (75%) bioprosthetic root replacement (5 xenografts and 7 allografts), and 4 of 12 (33%) mechanical root replacement cases. Multivariate analysis revealed that the 1-month postdischarge C-reactive protein level and operative age were independent predictive factors for postoperative event-free survival. Mechanical root replacement was identified as the most significant predictive factor leading to positive outcomes (hazard ratio, 0.147; 95% confidence interval, 0.028 to 0.766; p = 0.023).Conclusions. The findings suggest that mechanical root replacement combined with a low postoperative C-reactive protein level maintained through adjunctive immunomodulation therapy may lead to optimal surgical outcomes in Behcet's disease associated with severe aortic regurgitation. (C) 2019 by The Society of Thoracic Surgeons