JTCVS open · 2026
Moderate or severe aortic valve disease in patients with successful rheumatic mitral and tricuspid valve repair: Efforts to repair valve.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Zhou, Liu Chuang, Liu Ruifei, Zhang Yazhe, Liang Jiajun, Han Jie, Meng Xu, Wang Meili, Zhang Hongjia, Jiang Wenjian
Аннотация
OBJECTIVE: The management of aortic valve (AV) disease in patients with rheumatic heart disease (RHD) undergoing multivalve surgery remains uncertain. This study aimed to compare the long-term outcomes of AV repair versus AV replacement in patients with RHD undergoing combined mitral and tricuspid valve repair.
METHODS: We conducted a retrospective cohort study of 288 patients with RHD who underwent combined mitral and tricuspid valve repair with either AV repair (n = 122) or AV replacement (n = 166) at Beijing Anzhen Hospital from January 2015 to August 2024. The primary outcomes were overall survival and freedom from valve-related events. Kaplan-Meier survival analysis and inverse probability of treatment weighting were used to adjust for baseline differences and compare the groups.
RESULTS: The cohort had a mean age of 56.4 ± 9.8 years, and 33.3% were male. The AV repair group was younger and had less-severe baseline AV disease. After AV repair, 91.8% of patients achieved improved valve function. AV repair was associated with shorter cardiopulmonary bypass (147.6 vs 168.2 minutes) and aortic crossclamp times (117.9 vs 134.1 minutes), as well as lower postoperative mean AV gradients (13.1 vs 18.8 mm Hg). Residual aortic regurgitation occurred in 81.1% of the repair group, but severe AV dysfunction or reoperation was rare (4/122). Kaplan-Meier analysis revealed no significant difference in overall survival (P = .56) and freedom from valve-related events (P = .21) between the 2 groups, with curves adjusted by inverse probability of treatment weighting showing consistent results.
CONCLUSIONS: AV repair is a feasible and safe alternative to replacement in selected patients with RHD undergoing multivalve surgery, offering favorable early hemodynamics and comparable midterm outcomes.
METHODS: We conducted a retrospective cohort study of 288 patients with RHD who underwent combined mitral and tricuspid valve repair with either AV repair (n = 122) or AV replacement (n = 166) at Beijing Anzhen Hospital from January 2015 to August 2024. The primary outcomes were overall survival and freedom from valve-related events. Kaplan-Meier survival analysis and inverse probability of treatment weighting were used to adjust for baseline differences and compare the groups.
RESULTS: The cohort had a mean age of 56.4 ± 9.8 years, and 33.3% were male. The AV repair group was younger and had less-severe baseline AV disease. After AV repair, 91.8% of patients achieved improved valve function. AV repair was associated with shorter cardiopulmonary bypass (147.6 vs 168.2 minutes) and aortic crossclamp times (117.9 vs 134.1 minutes), as well as lower postoperative mean AV gradients (13.1 vs 18.8 mm Hg). Residual aortic regurgitation occurred in 81.1% of the repair group, but severe AV dysfunction or reoperation was rare (4/122). Kaplan-Meier analysis revealed no significant difference in overall survival (P = .56) and freedom from valve-related events (P = .21) between the 2 groups, with curves adjusted by inverse probability of treatment weighting showing consistent results.
CONCLUSIONS: AV repair is a feasible and safe alternative to replacement in selected patients with RHD undergoing multivalve surgery, offering favorable early hemodynamics and comparable midterm outcomes.