Importance of surgeon's experience in practicing valve-sparing aortic root replacement

JTCVS open Pub Date : 2024-10-01 DOI:10.1016/j.xjon.2024.07.013

Kavya Rajesh BS , Megan Chung BA , Dov Levine MD , Elizabeth Norton MD , Parth Patel MD , Yu Hohri MD, PhD , Chris He BS , Paridhi Agarwal BS , Yanling Zhao MS, MPH , Pengchen Wang MS , Paul Kurlansky MD , Edward Chen MD , Hiroo Takayama MD, PhD

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引用次数: 0

Abstract

Background

Valve-sparing root replacement (VSRR) requires a unique skill set. This study aimed to examine the influence of surgeon's procedural volume on outcomes of VSRR.

Methods

This retrospective study included 1697 patients from 2 large, high-volume aortic centers who underwent aortic root replacement (ARR) between 2004 and 2021 and were potentially eligible for VSRR. Surgeons were classified as performing <5 ARRs or ≥5 ARRs annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and the decision to perform VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR surgeons or ≥5 ARR surgeons and compare long-term survival probability. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation.

Results

Of 1697 patients who met the study inclusion criteria, 944 underwent composite-valve conduit ARR and 753 underwent VSRR. The median age of the cohort was 57 years (interquartile range, 45-66 years), and 268 (15.8%) were female. Aortic insufficiency was present in 1105 patients (65.1%), and 200 of the procedures (11.8%) were reoperations. The indication for surgery was aneurysm in 1496 patients (88.2%) and dissection in 201 (11.8%). Among the 743 patients who underwent VSRR, 691 (92%) were operated on by ≥ 5 ARR surgeons and 62 (8%) were operated on by <5 ARR surgeons. In multivariable logistic regression, ≥5 ARRs (odds ratio, 3.33; 95% confidence interval, 2.34-4.73; P < .001) was associated with VSRR as the procedure of choice. Following IPTW, there was no significant difference between <5 ARR and ≥5 ARR surgeons in survival probability after VSRR (P = .59) or in the rate of aortic valve reoperation (P = .60).

Conclusions

In the setting of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by <5 ARR surgeons.

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外科医生的经验对实施主动脉根部瓣膜置换术的重要性

背景瓣膜保留根部置换术（VSRR）需要一套独特的技能。本研究旨在探讨外科医生的手术量对 VSRR 结果的影响。本回顾性研究纳入了 2004 年至 2021 年期间在 2 个大型、高手术量主动脉中心接受主动脉根置换术（ARR）且可能符合 VSRR 条件的 1697 例患者。外科医生被分为每年实施 5 例 ARR 或 ≥5 例 ARR。多变量逻辑回归用于检验外科医生的手术量与实施 VSRR 的决定之间的独立关联。采用反概率治疗加权法（IPTW）匹配由<5 ARR外科医生或≥5 ARR外科医生手术的患者，并比较长期生存概率。结果在符合研究纳入标准的1697名患者中，944人接受了复合瓣膜导管ARR手术，753人接受了VSRR手术。组群的中位年龄为 57 岁（四分位间范围为 45-66 岁），女性 268 人（15.8%）。1105名患者（65.1%）存在主动脉瓣关闭不全，其中200例（11.8%）为再次手术。1496名患者（88.2%）的手术指征是动脉瘤，201名患者（11.8%）的手术指征是夹层。在接受 VSRR 的 743 位患者中，691 位（92%）由≥5 位 ARR 外科医生实施手术，62 位（8%）由 <5 位 ARR 外科医生实施手术。在多变量逻辑回归中，≥5 位 ARR（几率比，3.33；95% 置信区间，2.34-4.73；P <.001）与 VSRR 成为首选手术相关。在 IPTW 之后，<5 ARR 和 ≥5 ARR 外科医生在 VSRR 后的存活概率（P = .59）或主动脉瓣再手术率（P = .60）方面没有显著差异。结论在大容量主动脉中心的环境中，如果由<5 ARR 外科医生进行手术，接受 ARR 的患者接受 VSRR 的可能性较低；但是，<5 ARR 外科医生可以安全地进行 VSRR。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

发文量