Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database

详细信息    查看全文

• 作者：Vikrant Dhurandhar ; MBBS^a ; ^b ; ^c ; ^{vikrantdhurandhar@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; Roneil Parikh ; MBBS^a ; ^b ; ^c ; Akshat Saxena ; MBBS ; MS^a ; ^c ; Michael P. Vallely ; MBBS ; FRACS ; PhD^a ; ^b ; ^c ; ^d ; Michael K. Wilson ; MBBS ; FRACS^a ; ^b ; ^c ; ^d ; Deborah Ann Black ; MStat ; DipEd ; PhD^e ; Lavinia Tran ; PhD^f ; Christopher Reid ; PhD^f ; Paul G. Bannon ; MBBS ; FRACS ; PhD^a ; ^b ; ^c ; ^d
• 关键词：Valve sparing aortic root reconstruction ; Valve sparing surgery ; David procedure ; Yacoub procedure ; Outcomes ; Survival ; Morbidity ; Mortality
• 刊名：Heart, Lung and Circulation
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：25
• 期：5
• 页码：505-511
• 全文大小：369 K

文摘

Valve sparing aortic root reconstruction (VSARR) has become an alternative to traditional aortic root replacement with a valved conduit. There have been various modifications but the two broad types are aortic root reimplantation and the aortic root remodelling procedure. We present the early and late outcomes following valve sparing aortic root reconstruction surgery in Australia.

Methods

spar0010">We reviewed the ANZSCTS database for patients undergoing these procedures. Preoperative, intraoperative and postoperative variables were analysed. Multivariable regression was performed to determine independent predictors of 30-day mortality. We also obtained five- and 10-year survival estimates by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare's National Death Index.

Results

spar0015">Between January 2001 and January 2012, 169 consecutive patients underwent VSARR procedures. The mean age of the study population was 54.4 years with 31.4% being females. Overall, nine patients (5.9%) died within 30 days post procedure and five patients (3%) had permanent strokes. However, out of 132 elective cases, only five patients died (3.8%). Independent predictors of 30-day mortality were female gender [OR 5.65(1.24-25.80), p=0.025], preoperative atrial arrhythmia [OR 6.07(1.14-32.35), p=0.035] and acute type A aortic dissection [OR 7.71(1.63-36.54), p=0.01]. Long-term survival was estimated as 85.3% and 72.7% at five- and 10-years, respectively.

Conclusions

spar0020">Along with an acceptable rate of early mortality and stroke, VSARR procedures provide good long-term survival according to the ANZSCTS database. As promising procedure for pathologies that impair the aortic root integrity, they can be adopted more widely, especially in Australian and New Zealand centres with experienced aortic units. Future studies are planned to assess freedom from valve deterioration and repeat surgery.