Management of the dissected aortic root in young patients: A propensity score-matched analysis of mechanical versus bioprosthetic aortic root replacement

IF 1.9
Michael A. Catalano MD , Omar Toubat MD, PhD , Lauren Gillinov BS , Kendall M. Lawrence MD , Yu Zhao MS , John J. Kelly MD , Nicholas J. Goel MD , Alexandra Sperry MD , Wilson Y. Szeto MD , Chase R. Brown MD , Nimesh D. Desai MD, PhD
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引用次数: 0

Abstract

Objective

Valve selection in acute type A aortic dissection (ATAAD) requiring aortic root replacement is challenging given the clinical acuity, unknown patient preferences, risk of surgical bleeding, and limited life expectancy. We sought to identify long-term outcomes of mechanical versus bioprosthetic aortic root replacement in young patients with ATAAD.

Methods

Retrospective review of our institution's database of ATAAD was conducted to identify patients aged 65 years and younger who underwent mechanical Bentall (mech-Bentall) or bioprosthetic Bentall (bio-Bentall) for ATAAD from 2002 to 2022. The primary end point was 10-year survival, which was compared in a propensity score-matched cohort and multivariable Cox proportional hazards model. A composite outcome of 10-year freedom from death, stroke, major bleeding, and valvular reintervention was assessed as a secondary end point.

Results

Of 1114 patients who underwent ATAAD repair, there were 79 mech-Bentalls and 67 bio-Bentalls in patients aged 65 years or younger. Patients undergoing mech-Bentall were younger, and they were less likely to undergo an extended arch operation; there was no difference in gender, race, comorbidities, or malperfusion on presentation. In a propensity score-matched analysis, mech-Bentall patients demonstrated a nonsignificant increase in 10-year mortality (P = .058) and demonstrated higher rates of the composite end point (P = .026). In a Cox proportional hazards model, mech-Bentall (hazard ratio, 1.892; P = .023) was independently associated with 10-year composite end point occurrence.

Conclusions

There is no survival advantage of mech-Bentall in ATAAD in young patients at 10 years, and it is associated with a significantly higher rate of morbid complications. When the aortic valve cannot be spared, bio-Bentall should be considered in ATAAD, even in young patients.

Abstract Image

年轻患者主动脉根部夹层的处理:机械与生物假体主动脉根部置换的倾向评分匹配分析
目的:考虑到临床灵敏度、未知的患者偏好、手术出血风险和有限的预期寿命,需要主动脉根置换术的急性A型主动脉夹层(ATAAD)患者的瓣膜选择具有挑战性。我们试图确定机械式与生物假体主动脉根部置换术对年轻ATAAD患者的长期疗效。方法回顾性分析我院的ATAAD数据库,选取2002年至2022年接受机械Bentall (mech-Bentall)或生物假体Bentall (bio-Bentall)治疗ATAAD的65岁及以下患者。主要终点为10年生存率,通过倾向评分匹配队列和多变量Cox比例风险模型进行比较。10年无死亡、卒中、大出血和瓣膜再干预的综合结局作为次要终点进行评估。结果1114例接受ATAAD修复的患者中,65岁及以下的患者中有79例为机械本特尔,67例为生物本特尔。接受mech-Bentall手术的患者更年轻,他们不太可能接受延长弓手术;在性别、种族、合并症或表现时灌注不良方面没有差异。在倾向评分匹配分析中,mech-Bentall患者的10年死亡率无显著增加(P = 0.058),复合终点率较高(P = 0.026)。在Cox比例风险模型中,mech-Bentall(风险比为1.892,P = 0.023)与10年复合终点发生率独立相关。结论mech-Bentall治疗年轻ATAAD患者10年生存率无明显优势,且与较高的并发症发生率相关。当不能保留主动脉瓣时,即使是年轻的ATAAD患者,也应考虑使用bio-Bentall。
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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