Emil Johannes Ravn, Lytfi Krasniqi, Viktor Poulsen, Poul Erik Mortensen, Bo Juel Kjeldsen, Jens Lund, Kristian Øvrehus, Oke Gerke, Rasmus Carter-Storch, Morten Holdgaard Smerup, Ivy Susanne Modrau, Torsten Bloch Rasmussen, Katrine M Müllertz, Marie-Annick Clavel, Jordi Sanchez Dahl, Lars Peter Schødt Riber
{"title":"保留主动脉瓣根置换术和复合根置换术:丹麦多中心全国性研究。","authors":"Emil Johannes Ravn, Lytfi Krasniqi, Viktor Poulsen, Poul Erik Mortensen, Bo Juel Kjeldsen, Jens Lund, Kristian Øvrehus, Oke Gerke, Rasmus Carter-Storch, Morten Holdgaard Smerup, Ivy Susanne Modrau, Torsten Bloch Rasmussen, Katrine M Müllertz, Marie-Annick Clavel, Jordi Sanchez Dahl, Lars Peter Schødt Riber","doi":"10.1093/ehjopen/oeaf112","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Aortic valve-sparing root replacement is recommended over composite root replacement for aortic root aneurysms, especially in younger patients, but long-term outcomes in low-volume nationwide settings remain unclear. The objectives are to compare long-term survival, stroke, and reoperation rates between the two procedures in a low-volume national setting.</p><p><strong>Methods and results: </strong>Patients were identified from the Western Danish Heart Registry and the Danish Heart Registry. Cases were validated by review of operative descriptions. The primary outcome was long-term survival from all-cause mortality; secondary outcomes included stroke, reoperation, recurrent aortic regurgitation, and aortic stenosis. Groups were balanced using propensity score matching. Echocardiographic data were provided for the matched cohort. We identified 760 patients treated with composite root replacement and 179 patients with aortic valve-sparing root replacement between January 2010 and April 2022. Mean follow-up was 6.5 years. Composite root replacement patients were younger [50.7 years (SD 14.1) vs. 55.2 (SD 13.5), <i>P</i> < 0.001], but more comorbid with a median EuroSCOREII of 5.5 [interquartile range (IQR): 3.3-11.7] vs. 3.4 (IQR: 2.6-5.0) (<i>P</i> < 0.001). After matching 157 patients per group, aortic valve-sparing root replacement showed improved 10-year survival [91.2%, 95% confidence interval (CI) 82.3-95.8 vs. 80.4%, 95% CI 70.0-87.5, log-rank <i>P</i> = 0.026], with lower 10-year stroke risk (4.9%, 95% CI 1.8-13.0 vs. 18.9%, 95% CI 11.7-29.9, log-rank <i>P</i> = 0.007). Risk of reoperation was nonsignificant (log-rank <i>P</i> = 0.12), which was consistent in the crude population when accounting for competing risk of death (log-rank <i>P</i> = 0.09).</p><p><strong>Conclusion: </strong>In this nationwide study, aortic valve-sparing root replacement was associated with better long-term survival and lower stroke risk, supporting its role as a durable surgical option for selected patients.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 5","pages":"oeaf112"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449084/pdf/","citationCount":"0","resultStr":"{\"title\":\"Aortic valve-sparing root replacement and composite root replacement: a Danish multicentre nationwide study.\",\"authors\":\"Emil Johannes Ravn, Lytfi Krasniqi, Viktor Poulsen, Poul Erik Mortensen, Bo Juel Kjeldsen, Jens Lund, Kristian Øvrehus, Oke Gerke, Rasmus Carter-Storch, Morten Holdgaard Smerup, Ivy Susanne Modrau, Torsten Bloch Rasmussen, Katrine M Müllertz, Marie-Annick Clavel, Jordi Sanchez Dahl, Lars Peter Schødt Riber\",\"doi\":\"10.1093/ehjopen/oeaf112\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Aortic valve-sparing root replacement is recommended over composite root replacement for aortic root aneurysms, especially in younger patients, but long-term outcomes in low-volume nationwide settings remain unclear. The objectives are to compare long-term survival, stroke, and reoperation rates between the two procedures in a low-volume national setting.</p><p><strong>Methods and results: </strong>Patients were identified from the Western Danish Heart Registry and the Danish Heart Registry. Cases were validated by review of operative descriptions. The primary outcome was long-term survival from all-cause mortality; secondary outcomes included stroke, reoperation, recurrent aortic regurgitation, and aortic stenosis. Groups were balanced using propensity score matching. Echocardiographic data were provided for the matched cohort. We identified 760 patients treated with composite root replacement and 179 patients with aortic valve-sparing root replacement between January 2010 and April 2022. Mean follow-up was 6.5 years. Composite root replacement patients were younger [50.7 years (SD 14.1) vs. 55.2 (SD 13.5), <i>P</i> < 0.001], but more comorbid with a median EuroSCOREII of 5.5 [interquartile range (IQR): 3.3-11.7] vs. 3.4 (IQR: 2.6-5.0) (<i>P</i> < 0.001). After matching 157 patients per group, aortic valve-sparing root replacement showed improved 10-year survival [91.2%, 95% confidence interval (CI) 82.3-95.8 vs. 80.4%, 95% CI 70.0-87.5, log-rank <i>P</i> = 0.026], with lower 10-year stroke risk (4.9%, 95% CI 1.8-13.0 vs. 18.9%, 95% CI 11.7-29.9, log-rank <i>P</i> = 0.007). 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引用次数: 0
摘要
目的:保留主动脉瓣的根置换术比复合根置换术更适用于主动脉根动脉瘤的治疗,尤其是在年轻患者中,但在全国范围内小容量环境下的长期结果尚不清楚。目的是比较两种手术在低容量国家环境下的长期生存率、卒中和再手术率。方法和结果:从西丹麦心脏登记处和丹麦心脏登记处确定患者。病例通过检查手术描述进行验证。主要终点是全因死亡率的长期生存;次要结局包括卒中、再手术、主动脉返流复发和主动脉狭窄。使用倾向得分匹配来平衡各组。提供匹配队列的超声心动图数据。在2010年1月至2022年4月期间,我们发现760例患者接受了复合根置换术,179例患者接受了保留主动脉瓣的根置换术。平均随访时间为6.5年。复合牙根置换患者更年轻[50.7岁(SD 14.1)对55.2岁(SD 13.5), P < 0.001],但EuroSCOREII中位数为5.5[四分位间距(IQR): 3.3-11.7]对3.4 (IQR: 2.6-5.0) (P < 0.001)更合并症。每组匹配157例患者后,保留主动脉瓣根置换术显示10年生存率提高[91.2%,95%可信区间(CI) 82.3-95.8 vs. 80.4%, 95% CI 70.0-87.5, log-rank P = 0.026], 10年卒中风险降低(4.9%,95% CI 1.8-13.0 vs. 18.9%, 95% CI 11.7-29.9, log-rank P = 0.007)。再手术风险不显著(log-rank P = 0.12),当考虑竞争死亡风险时,这在粗人群中是一致的(log-rank P = 0.09)。结论:在这项全国性的研究中,保留主动脉瓣的根置换术与更好的长期生存和更低的卒中风险相关,支持其作为选定患者的持久手术选择的作用。
Aortic valve-sparing root replacement and composite root replacement: a Danish multicentre nationwide study.
Aims: Aortic valve-sparing root replacement is recommended over composite root replacement for aortic root aneurysms, especially in younger patients, but long-term outcomes in low-volume nationwide settings remain unclear. The objectives are to compare long-term survival, stroke, and reoperation rates between the two procedures in a low-volume national setting.
Methods and results: Patients were identified from the Western Danish Heart Registry and the Danish Heart Registry. Cases were validated by review of operative descriptions. The primary outcome was long-term survival from all-cause mortality; secondary outcomes included stroke, reoperation, recurrent aortic regurgitation, and aortic stenosis. Groups were balanced using propensity score matching. Echocardiographic data were provided for the matched cohort. We identified 760 patients treated with composite root replacement and 179 patients with aortic valve-sparing root replacement between January 2010 and April 2022. Mean follow-up was 6.5 years. Composite root replacement patients were younger [50.7 years (SD 14.1) vs. 55.2 (SD 13.5), P < 0.001], but more comorbid with a median EuroSCOREII of 5.5 [interquartile range (IQR): 3.3-11.7] vs. 3.4 (IQR: 2.6-5.0) (P < 0.001). After matching 157 patients per group, aortic valve-sparing root replacement showed improved 10-year survival [91.2%, 95% confidence interval (CI) 82.3-95.8 vs. 80.4%, 95% CI 70.0-87.5, log-rank P = 0.026], with lower 10-year stroke risk (4.9%, 95% CI 1.8-13.0 vs. 18.9%, 95% CI 11.7-29.9, log-rank P = 0.007). Risk of reoperation was nonsignificant (log-rank P = 0.12), which was consistent in the crude population when accounting for competing risk of death (log-rank P = 0.09).
Conclusion: In this nationwide study, aortic valve-sparing root replacement was associated with better long-term survival and lower stroke risk, supporting its role as a durable surgical option for selected patients.