Fifteen-Year Outcomes After Valve-Sparing Aortic Root Remodelling or Exclusion of the Non-Coronary Sinus: When to Preserve the Sinuses of Valsalva?

Autor: Liu Y; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France; Department of Cardiovascular Surgery and Transplantation, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Benzha MY; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Dan P; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Hubert M; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Piccoli J; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Lauria G; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Vanhuyse F; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Sirbu C; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Gauchotte G; Department of Anatomo-pathology, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Dong N; Department of Cardiovascular Surgery and Transplantation, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China., Villemot JP; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France., Maureira JP; Department of Cardiovascular Surgery and Transplantation, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France. Electronic address: Pablomaureira@hotmail.com.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2022 Sep; Vol. 31 (9), pp. 1291-1299. Date of Electronic Publication: 2022 May 31.
DOI: 10.1016/j.hlc.2022.04.051
Abstrakt: Background: Isolated exclusion of the non-coronary sinus (NCS) is an attractive strategy in valve-sparing aortic root surgery, which avoids the mobilisation and re-implantation of coronary ostia. However, the long-term durability of aortic valve repair and the fate of remnant sinuses of Valsalva remain unclear.
Method: From January 2006 to December 2013, 29 patients underwent replacement of the ascending aorta extending to the NCS (group NCS) and 56 patients underwent a modified Yacoub procedure (group MY) in our centre by a single surgeon. Significant difference of preoperative parameters was observed between two groups in the presence of bicuspid aortic valve (41.4% vs 12.5%, p=0.002) and the diameter of the sinus of Valsalva (47.3±4.7 mm vs 51.5±4.9 mm, p=0.01).
Results: The group NCS, as compared to the group MY, was associated with significantly shorter cardiopulmonary bypass time (106.6±40.5 min vs 138.4±37.5 min, p=0.001) and aortic cross clamping time (69.0±21.8 min vs 105.4±27.8 min, p<0.01). The mean follow-up was 11.5±2.8 years. No surgical re-intervention was performed for aortopathies of the aortic root; the neo-sinus were not dilated in either groups (38.2±4.2 mm vs 34.0±4.0 mm, p<0.01). The 10-year freedom from aortic valve-related re-operation was estimated to be 96.6±3.4% and 94.5±3.1% (p=0.58), and the cumulative 10-year survival rates were 95.2±4.6% and 85.6±4.7% (p=0.61) in the group NCS and the group MY, respectively.
Conclusions: Aortic valve-sparing isolated NCS replacement can be safely performed in selected patients; its early outcomes, overall survival and long-term freedom from aortic valve-related or aortopathy-related re-intervention were comparable to those obtained with the Yacoub procedure.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
Externí odkaz: