Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome
Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome
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DOI：
10.1016/j.jacc.2015.03.575
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发表时间：
2015-06-09
影响因子：
24
通讯作者：
Adams, David H.
中科院分区：
文献类型：
--
作者：
Itagaki, Shinobu;Chikwe, Joanna P.;Adams, David H.
背景二叶式主动脉瓣与瓣膜功能障碍、升主动脉瘤和夹层有关。在这些患者中，主动脉瓣置换术（AVR）时升主动脉的管理是有争议的，并且是从马凡综合征的经验中推断出来的，尽管缺乏比较长的本研究旨在评估二叶主动脉瓣疾病患者主动脉瓣置换术后胸主动脉病的自然史是否与马凡氏病患者有实质性差异方法：在这项回顾性比较中，比较了1995年至2010年期间在纽约州接受初次主动脉瓣置换术而未置换升主动脉的13，205例成人（2，079例二叶式主动脉瓣患者，73例马凡综合征患者，11，053例获得性主动脉瓣疾病对照患者）的结局。结果马凡综合征患者胸主动脉夹层的长期发生率（5.5 ± 2.7%）明显高于二尖瓣组（0.55 ± 0.21%）和对照组（0.41 ± 0.08%），P < 0.001。马凡综合征患者（10.8 ± 4.4%）在后期随访中诊断胸主动脉瘤的可能性明显高于二尖瓣组（4.8 ± 0.8%）和对照组（1.4 ± 0.2%）（p < 0.001）。马凡氏综合征患者在后期随访时明显更可能接受胸主动脉手术（10.4 +/- 4.3%）与二尖瓣相比（2.5 ± 0.6%）和对照组患者（0.50 +/- 0.09%）（p < 0.001）。结论：与二叶式主动脉瓣患者相比，在马凡综合征患者中观察到主动脉瓣置换术后主动脉并发症的长期发生率证实了二叶式主动脉瓣患者的手术治疗不应该从马凡氏综合征外推，并支持这些不同临床实体的离散治疗算法。(C)2015年美国心脏病学院基金会。
BACKGROUND Bicuspid aortic valves are associated with valve dysfunction, ascending aortic aneurysm and dissection. Management of the ascending aorta at the time of aortic valve replacement (AVR) in these patients is controversial and has been extrapolated from experience with Marfan syndrome, despite the absence of comparative long-term outcome data.OBJECTIVES This study sought to assess whether the natural history of thoracic aortopathy after AVR in patients with bicuspid aortic valve disease is substantially different from that seen in patients with Marfan syndrome.METHODS In this retrospective comparison, outcomes of 13,205 adults (2,079 with bicuspid aortic valves, 73 with Marfan syndrome, and 11,053 control patients with acquired aortic valve disease) who underwent primary AVR without replacement of the ascending aorta in New York State between 1995 and 2010 were compared. The median follow-up time was 6.6 years.RESULTS The long-term incidence of thoracic aortic dissection was significantly higher in patients with Marfan syndrome (5.5 +/- 2.7%) compared with those with bicuspid valves (0.55 +/- 0.21%) and control group patients (0.41 +/- 0.08%, p < 0.001). Thoracic aortic aneurysms were significantly more likely to be diagnosed in late follow-up in patients with Marfan syndrome (10.8 +/- 4.4%) compared with those with bicuspid valves (4.8 +/- 0.8%) and control group patients (1.4 +/- 0.2%) (p < 0.001). Patients with Marfan syndrome were significantly more likely to undergo thoracic aortic surgery in late follow-up (10.4 +/- 4.3%) compared with those with bicuspid valves (2.5 +/- 0.6%) and control group patients (0.50 +/- 0.09%) (p < 0.001).CONCLUSIONS The much higher long-term rates of aortic complications after AVR observed in patients with Marfan syndrome compared with those with bicuspid aortic valves confirm that operative management of patients with bicuspid aortic valves should not be extrapolated from Marfan syndrome and support discrete treatment algorithms for these different clinical entities. (C) 2015 by the American College of Cardiology Foundation.