Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve
Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve
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主动脉瓣关闭不全对二叶式主动脉瓣患者孤立性主动脉瓣置换术后升主动脉扩张和不良主动脉事件的影响
DOI：
10.1016/j.athoracsur.2015.10.047
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发表时间：
2016-05-01
影响因子：
4.6
通讯作者：
Shu, Xianhong
中科院分区：
文献类型：
--
作者：
Wang, Yongshi;Wu, Boting;Shu, Xianhong
背景异常的血流模式和先天性的脆弱性使二叶式主动脉瓣（BAV）具有升主动脉扩张、动脉瘤和夹层的倾向。单纯主动脉瓣置换术（AVR）是否能防止BAV升主动脉进一步扩张，以及在瓣膜手术的情况下，什么样的主动脉介入治疗仍存在争议。从2006年6月至2009年1月，连续纳入接受单独AVR的BAV患者，并将其分类为主动脉瓣关闭不全（BAV-AI，n = 84）和主动脉瓣狭窄（n = 112）组，和另一个三尖瓣主动脉瓣伴主动脉瓣关闭不全患者人群（n = 149）在同一时期，还招募了一名研究人员，以比较孤立性AVR后的年主动脉扩张率和主动脉不良事件。中位随访期为72个月（四分位距，66至78个月），BAV-AI组的升主动脉扩张率快于BAV+主动脉瓣狭窄组和三尖瓣主动脉瓣伴主动脉瓣关闭不全组（均p < 0.001）。与BAV+主动脉瓣狭窄（15.5% vs 4.5%; p = 0.008）和三尖瓣主动脉瓣伴主动脉瓣关闭不全（15.5% vs 6.0%; p = 0.018）组相比，BAV-AI组显示出更高的主动脉不良事件风险。考克斯回归分析确定了主动脉瓣关闭不全（风险比，3.7; 95%置信区间，1.2 - 11.1; p = 0.019）作为BAV患者中主动脉不良事件的独立风险因素，而术前升主动脉直径大于45 mm（风险比，13.8; 95%可信区间，3.0 ~ 63.3; p = 0.001）作为BAV-AI组的预后指标。在AVR期间，预防性主动脉介入的积极政策似乎适用于BAV-AI患者，在考虑BAV动脉病的最佳手术策略时，应考虑表现为功能不全或狭窄的BAV表型。(C)2016胸外科医师协会
Background. Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial.Methods. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR.Results. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p < 0.001). The BAV-AI group showed a higher risk for adverse aortic events compared with both the BAV plus aortic stenosis (15.5% versus 4.5%; p = 0.008) and tricuspid aortic valve with aortic insufficiency (15.5% versus 6.0%; p = 0.018) groups. Cox regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group.Conclusions. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. (C) 2016 by The Society of Thoracic Surgeons