Comparison of Two Strategies for Aortic Valve-Sparing Root Replacement
Comparison of Two Strategies for Aortic Valve-Sparing Root Replacement
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DOI：
10.1016/j.athoracsur.2019.07.006
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发表时间：
2020-02-01
影响因子：
4.6
通讯作者：
Pacini, Davide
中科院分区：
文献类型：
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作者：
Beckmann, Erik;Leone, Alessandro;Pacini, Davide
背景自1992年引入以来，已经描述了主动脉瓣保留大卫手术技术的多种变化。在此，我们介绍了2个中心在接受单独大卫手术的患者中使用直管移植物（David-I）和Valsalva假体的短期和中期结果。2002年3月至2015年10月期间，232例患者在2家欧洲中心接受了大卫手术。患者接受了直管移植物（David-I，A组，n = 103，74%男性）或Valsalva移植物（B组，n = 129，85%男性）。A组平均年龄为47 ± 17岁，B组为48 ± 17岁（P = 0.916）。B组（n = 28，22%）的瓣尖修复明显多于A组（n = 4，4%，P <0.001）。A组的30天死亡率为1%（n = 1），B组为2%（n = 2，P = 0.698）。术后超声心动图显示主动脉瓣关闭不全>= II，A组为0%（n = 0），B组为17%（n = 21）（P < .001）。随访时间为1530患者年，两组的生存率相当（P = .799）。随访超声心动图显示主动脉瓣关闭不全>= II级的A组为22%（n = 15），B组为39%（n = 33）（P <0.026）。A组和B组的主动脉瓣相关再手术率分别为8%（n = 8）和13%（n = 16）（P = 0.241）。Logistic考克斯回归分析显示，主动脉瓣二叶化（优势比，3.435; 95%可信区间，1.459-8.083，P = .005）和术后主动脉瓣关闭不全≥ II（优势比，5.988; 95%可信区间，2.545-14.088，P < .001）是主动脉瓣相关再手术的危险因素。主动脉瓣保留大卫手术的中期结果可接受。我们的研究结果表明，采用直管移植物的David-I手术并不劣于采用Valsalva假体的手术。(C)2020年美国胸外科医师协会
Background. Since its introduction in 1992, multiple variations of the aortic valve-sparing David procedure technique have been described. Here, we present the short- and midterm outcomes of 2 centers using the straight tube graft (David-I) and the Valsalva prosthesis in patients who underwent isolated David procedure.Methods. Between March 2002 and October 2015, 232 patients underwent the David procedure at 2 European centers. Patients received either a straight tube graft (David-I, group A, n = 103, 74% men) or Valsalva graft (group B, n = 129, 85% men). Mean age was 47 +/- 17 years in group A and 48 +/- 17 years in group B (P = .916).Results. There were significantly more cusp repairs in group B (n = 28, 22%) compared with group A (n = 4, 4%, P < .001). The 30-day mortality rate was 1% (n = 1) in group A and 2% (n = 2, P = .698) in group B. Postoperative echocardiography showed aortic insufficiency >= II in 0% (n = 0) of group A and 17% (n = 21) of group B (P < .001). Follow-up comprised 1530 patient-years, and survival was comparable between the 2 groups (P = .799). Follow-up echocardiography showed aortic insufficiency >= II in 22% (n = 15) of group A and 39% (n = 33) of group B (P < .026). The rates for aortic valve-related reoperation were 8% (n = 8) in group A and 13% (n = 16) in group B (P = .241). Logistic Cox regression analysis identified bicuspid aortic valve (odds ratio, 3.435; 95% confidence interval, 1.459-8.083, P = .005) and postoperative aortic insufficiency >= II (odds ratio, 5.988; 95% confidence interval, 2.545-14.088, P < .001) as risk factors for aortic valve-related reoperation.Conclusions. The aortic valve-sparing David procedure has acceptable midterm results. Our results show that the David-I procedure with straight tube graft is not inferior to those performed with Valsalva prosthesis. (C) 2020 by The Society of Thoracic Surgeons