Longevity After Aortic Root Replacement Is the Mechanically Valved Conduit Really the Gold Standard for Quinquagenarians?

Article; Proceedings Paper

关键词: SINGLE-CENTER EXPERIENCE;    HEART-VALVE;    BENTALL PROCEDURE;    ASCENDING AORTA;    FOLLOW-UP;    IMPLANTATION;    RECONSTRUCTION;    BIOPROSTHESIS;    PROSTHESIS;    SURGERY;   

DOI  :  10.1161/CIRCULATIONAHA.112.000338

来源: SCIE

【 摘 要 】

Background-The choice of the best conduit for root/ascending disease and its impact on longevity remain controversial in quinquagenarians. Methods and Results-A total of 205 patients (men=155) between 50 and 60 years (mean, 55.7 +/- 2.9 years) received either a stentless porcine xenoroot (n=78) or a mechanically valved composite prosthesis (n=127) between February 1998 and July 2011. Of these, 166 patients underwent root replacement for aneurysmal disease (porcine: 39% [n=65]; mechanical: 61% [n=101]; P=0.5), 25 for acute type A aortic dissection (porcine: 32% [n=8]; mechanical: 68% [n=17]; P=0.51), and 14 for endocarditis/iatrogenic injury involving the aortic root (6.4% [n=5] versus 7.1% [n=9]; P=1.0). The predominant aortic valve pathology was stenosis in 19% (n=38), regurgitation in 50% (n=102), combined valvular dysfunction in 26% (n=54), and normal aortic valve function in 5% (n=11). Concomitant procedures included coronary artery bypass grafting (13%), mitral valve repair (7%), and partial/complete arch replacement (12%/4%), with no significant differences between porcine and mechanical root replacement. Overall hospital mortality was 7.3%, with no difference between the 2 types of valve prostheses (7.7% for porcine and 7.1% for mechanical root replacement; P=1.0). Follow-up averaged 5.4 +/- 3.7 years (1096 patient-years) and was 100% complete. Freedom from aorta-related reoperation at 12 years was not statistically different between the groups (porcine: 94.9% versus mechanical: 96.1%; P=0.73). Survival was equivalent between both groups, with a 5-year survival of 86 +/- 3% (porcine: 88 +/- 4%; mechanical: 85 +/- 3%; P=0.96) and a 10-year survival of 76% (porcine: 80 +/- 7%; mechanical: 75 +/- 5%; P=0.84). The linearized mortality rate was 3.1%/patient-year (porcine: 2.9%/patient-year; mechanical: 3.2%/patient-year). Conclusions-In quinquagenerians, long-term survival after stentless porcine xenograft aortic root replacement is equivalent to that after a mechanical Bentall procedure. These results bring into question the predominance of mechanical composite conduits for root replacement in quinquagenerians, particularly in the current era of transcatheter valve-invalve procedures for structural valve deterioration.

【 授权许可】

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