초록접수 현황
| 15F-074 | 구연 발표 |
Predictors of Worse Outcomes in Valve Sparing Aortic Root Reconstruction Surgery: Experience in 95 Patients
성기익, 장형우, 조양현, 정동섭, 김욱성, 이영탁, 박표원
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
Background : Valve-sparing aortic root reconstruction (VSARR) is superior as lifelong anticoagulation is not necessary. However, VSARR is known to need substantial learning effort. Also, durability of VSARR is controversial. We analyzed the outcomes and risk factors for recurrence of aortic regurgitation (AR) in VSARR.
Methods : From 2003 to 2014, a surgeon performed 95 VSARR in hospital. Mean patient age was 36±13 (13-67) years and 53 patients (56%) were male. The reason for operation varied; annuloaortic ectasia (AAE) (n=59, 62%), aortic dissection (n=24, 25%), AAE+aortic aneurysm (n=12, 13%). Seventy-seven patients (81%) had either Marfan or Loeys-Dietz syndrome, and 27 patients (28%) had moderate or greater degree of AR preoperatively. Methods of VSARR consisted of David I (n=65, 68%) and David V (n=30, 32%) operation. To analyze the learning effect, we separated the patients into the first half group (n=48, performed from 2003 to 2011) and the last half group (n=47, performed from 2011 to 2014). Also, risk factors of AR recurrence (≥moderate) were analyzed using multivariable analysis.
Results : There was no early death in the study population. Freedom from recurred AR at 3 years were 88±5% in the first half group and 100% in the last half group, P=0.193. Aortic crossclamp time significantly decreased in the last half group; first half group (198±54 minutes) vs last half group (167±50 minutes), P=0.006. Ten out of 30 patients (33%) in David V group showed AR recurrence, but only 2 out of 65 patients (3%) in David I group showed AR recurrence at final follow-up (P<0.001). Risk factor analysis showed that David V compared to David I significantly increases the risk of AR recurrence; HR 11.4, 95% CI 1.0-128.9, P=0.049. Aortic dissection, connective tissue disease, preoperative AR grade, and preoperative sinus of Valsalva size > 55 mm were not independent predictors of AR recurrence.
Conclusion : David I operation showed better freedom from AR recurrence compared to David V. Presence of steep learning curve was evidenced by decreased AR recurrence and aortic crossclamp time by period. In order to achieve good outcomes in VSARR, extensive experience and choice of proper surgical method may be necessary.
Methods : From 2003 to 2014, a surgeon performed 95 VSARR in hospital. Mean patient age was 36±13 (13-67) years and 53 patients (56%) were male. The reason for operation varied; annuloaortic ectasia (AAE) (n=59, 62%), aortic dissection (n=24, 25%), AAE+aortic aneurysm (n=12, 13%). Seventy-seven patients (81%) had either Marfan or Loeys-Dietz syndrome, and 27 patients (28%) had moderate or greater degree of AR preoperatively. Methods of VSARR consisted of David I (n=65, 68%) and David V (n=30, 32%) operation. To analyze the learning effect, we separated the patients into the first half group (n=48, performed from 2003 to 2011) and the last half group (n=47, performed from 2011 to 2014). Also, risk factors of AR recurrence (≥moderate) were analyzed using multivariable analysis.
Results : There was no early death in the study population. Freedom from recurred AR at 3 years were 88±5% in the first half group and 100% in the last half group, P=0.193. Aortic crossclamp time significantly decreased in the last half group; first half group (198±54 minutes) vs last half group (167±50 minutes), P=0.006. Ten out of 30 patients (33%) in David V group showed AR recurrence, but only 2 out of 65 patients (3%) in David I group showed AR recurrence at final follow-up (P<0.001). Risk factor analysis showed that David V compared to David I significantly increases the risk of AR recurrence; HR 11.4, 95% CI 1.0-128.9, P=0.049. Aortic dissection, connective tissue disease, preoperative AR grade, and preoperative sinus of Valsalva size > 55 mm were not independent predictors of AR recurrence.
Conclusion : David I operation showed better freedom from AR recurrence compared to David V. Presence of steep learning curve was evidenced by decreased AR recurrence and aortic crossclamp time by period. In order to achieve good outcomes in VSARR, extensive experience and choice of proper surgical method may be necessary.
책임저자: 성기익
성균관대학교 의과대학 삼성서울병원 흉부외과학교실
연락처 : 성기익, Tel: 02-3410-3489 , E-mail : wizski@hanmail.net
