The Journal of thoracic and cardiovascular surgery · 2025
Valve-sparing aortic root replacement in resternotomy settings.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chung Megan M, Rajesh Kavya, He Chris, Zhao Yanling, Hohri Yu, Jimenez Valeria, Owolabi Gift, Norton Elizabeth, Kurlansky Paul, Leshnower Bradley, Chen Edward P, Takayama Hiroo
Аннотация
OBJECTIVES: Although valve-sparing aortic root replacement (VSRR) has demonstrated satisfactory outcomes, its utility in reoperative sternotomy settings remains uncertain. This study evaluates the perioperative safety and long-term durability of reoperative sternotomy VSRR.
METHODS: All consecutive VSRR procedures at 2 centers from 2005 to 2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and the Fine-Gray subdistribution hazard model were used to identify factors associated with 10-year survival and aortic valve reintervention, respectively.
RESULTS: Of 778 VSRR procedures, 69 (8.9%) were reoperative sternotomies. Compared with primary, patients undergoing reoperative VSRR were younger (age 43 years [range, 34-54 years] vs age 51 years [range, 39-61 years]; P < .001) and had less aortic insufficiency (33.3% vs 48.5%; P = .02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%; P = .01) and prolonged ventilation (24.6% vs 9.9%; P < .001); operative mortality was higher in reoperative VSRR (2.9% [2 out of 69] vs 1.4% [10 out of 709]) although not significantly (P = .66). Ten-year survival was 82.0% (range, 70.0%-96.0%) and aortic valve reintervention rate was 11.8% (range, 2.3%-19.4%) after reoperative VSRR. After inverse probability of treatment weighting adjustment, survival and aortic valve reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (P = .13) or aortic valve reintervention (P = .77) on multivariable analysis.
CONCLUSIONS: Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and aortic valve reintervention rates were acceptable and comparable to primary VSRR.
METHODS: All consecutive VSRR procedures at 2 centers from 2005 to 2020 were included. Reoperative VSRR was defined as prior sternotomy for any reason. Time-dependent outcomes were compared between groups after balancing of covariates with inverse probability of treatment weighting. Multivariable Cox regression and the Fine-Gray subdistribution hazard model were used to identify factors associated with 10-year survival and aortic valve reintervention, respectively.
RESULTS: Of 778 VSRR procedures, 69 (8.9%) were reoperative sternotomies. Compared with primary, patients undergoing reoperative VSRR were younger (age 43 years [range, 34-54 years] vs age 51 years [range, 39-61 years]; P < .001) and had less aortic insufficiency (33.3% vs 48.5%; P = .02). Cardiopulmonary bypass times were longer in reoperative VSRR with similar rates of circulatory arrest. Reoperative VSRR had a higher incidence of postoperative acute kidney injury (10.1% vs 3.2%; P = .01) and prolonged ventilation (24.6% vs 9.9%; P < .001); operative mortality was higher in reoperative VSRR (2.9% [2 out of 69] vs 1.4% [10 out of 709]) although not significantly (P = .66). Ten-year survival was 82.0% (range, 70.0%-96.0%) and aortic valve reintervention rate was 11.8% (range, 2.3%-19.4%) after reoperative VSRR. After inverse probability of treatment weighting adjustment, survival and aortic valve reintervention rates were not different. Reoperative sternotomy was not associated with long-term mortality (P = .13) or aortic valve reintervention (P = .77) on multivariable analysis.
CONCLUSIONS: Although complex, reoperative sternotomy VSRR can be performed with low operative mortality in carefully selected patients. Ten-year survival and aortic valve reintervention rates were acceptable and comparable to primary VSRR.