Objective:This study aimed to compare perioperative outcomes between minimally invasive lower median sternotomy (LMS) and conventional full median sternotomy (FMS) in patients undergoing isolated aortic valve replacement (AVR). Methods:This retrospective cohort study enrolled 41 patients who underwent isolated AVR (25 via LMS, 16 via FMS). Patient demographics, intraoperative data, and early postoperative outcomes were analyzed and compared between the two groups. Results:The two groups were comparable in terms of baseline characteristics. There were no significant differences in intraoperative metrics, including operation time (LMS 238.6 ± 45.3 vs. FMS 264.9 ± 77.7 min, P = 0.177), cardiopulmonary bypass time (145.5 ± 41.6 vs. 140.9 ± 27.7 min, P = 0.700), and aortic cross-clamp time (116.4 ± 32.9 vs. 111.6 ± 23.1 min, P = 0.609). No red blood cell or plasma transfusion was required in either group. Postoperatively, there were no 30-day deaths or severe adverse events. The lengths of hospital stay (7.5 ± 3.6 vs. 7.6 ± 4.0 days, P = 0.972), ICU stay (1.9 ± 1.1 vs. 2.2 ± 1.0 days, P = 0.366), and mechanical ventilation time (12.5 ± 5.9 vs. 12.6 ± 5.3 h, P = 0.954) were similar between the two groups. Patient satisfaction with scar appearance was significantly higher in the LMS group than in the FMS group (92.0% vs. 37.5%, P = 0.001). Conclusion:LMS for isolated AVR represents a safe and feasible minimally invasive alternative to conventional FMS, with equivalent intraoperative efficiency and early postoperative safety profiles, and offers superior cosmetic outcomes. LMS offers a viable minimally invasive option without compromising procedural outcomes.

Paravalvular leak (PVL) remains a significant complication after transcatheter aortic valve replacement (TAVR). This study investigated the relationship between perioperative serum albumin levels and post-TAVR paravalvular leak. This retrospective observational study analyzed 1463 consecutive patients who underwent TAVR between 2013 and 2023. Serum albumin levels were measured preoperatively, immediately after procedure, and on postoperative days 1–5 and before discharge. Additional biomarkers including NT-proBNP and high-sensitivity troponin T were collected. Postprocedural echocardiography was used to assess PVL severity according to American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines. Primary endpoints included correlation between various albumin parameters and PVL severity. The cohort included 851 males (58.2

Accurate prediction of 30‑day mortality after transcatheter aortic valve replacement (TAVR) remains challenging. Existing models often overlook key preoperative laboratory variables. We aimed to develop and internally validate a preoperative risk prediction model using routinely available variables measured before the procedure.We state that predictors were preoperative‑only. We retrospectively analyzed 1,673 consecutive patients who underwent TAVR at Fuwai Hospital between 2013 and 2023. Patients were randomly split into a training cohort (n = 1,171) and an internal hold out validation cohort (n = 502). Candidate predictors were prespecified as routinely available preoperative variables. All candidate predictors, including laboratory parameters (troponin, D‑dimer, HbA1c, uric acid, etc.), were collected during the preoperative evaluation, within 3 days prior to the TAVR procedure. Independent predictors of 30-day mortality were identified using multivariable logistic regression. Performance was assessed with receiver operating characteristic (ROC) analysis, calibration assessment (calibration plots and Hosmer Lemeshow test), and bootstrap optimism correction; a nomogram was constructed from the final model. 30-day mortality was 3.4

Background and Objective: In clinical practice, valve-sparing aortic root replacement surgery primarily addresses left ventricular dysfunction in patients due to severe aortic regurgitation, but there is controversy regarding the choice of surgical technique. In order to investigate which type of valve-sparing aortic root replacement surgeries can achieve better blood flow conditions, this study examines the impact of changes in the geometric morphology of the aortic root on the hemodynamic environment through numerical simulation.Methods: An idealized model of the aortic root was established based on data obtained from clinical measurements, including using the model of the aortic root without significant lesions as the control group (Model C), while using surgical models of leaflet reimplantation with tubular graft (Model T), leaflet reimplantation with Valsalva graft (Model V), and the Florida sleeve procedure (Model F) as the experimental groups. Fluid-structure interaction numerical simulations were conducted to assess the differences in blood flow between the three surgical techniques.Results: Compared to the control group, all the three experimental groups showed no abnormal blood flow patterns in the aortic root. Additionally, the distribution of high-velocity blood flow was similar to that of the control group. Due to the changes in geometric shape after surgery, the impact locations of blood on the vessel wall varied, leading to different degrees of wall shear stress concentration at the sinus-conduit junction and the aortic valve ring in the three surgical models. During the peak systolic phase, the maximum opening area of the leaflets in the three surgical models (T, V, and F) differs from that of the control model, with the disparity in aortic valve leaflet opening area being 6.42%, 9.17%, and 8.63%, respectively. When comparing the leaflet closure states, it was found that the closure velocity in Model V was close to that of Model C.Conclusions: The changes in the geometry of the aortic sinus affect the hemodynamics within the aorta, and leaflet reimplantation with Valsalva graft and Florida sleeve procedures are more stable during blood flow impacts.

In valve-sparing aortic root replacement procedure, leaflet prolapse can be corrected by shortening the length of the free margin. But precisely determining the extent of the reduction remains a problem. This study wants to explore the effectiveness of a guiding strategy in treating the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring. Between January 2021 and May 2024, 12 patients with aortic root aneurysms underwent modified aortic root remodelling with an external sub-valvular ring (10 males and two females). Their mean age was 42 ± 14 years. The graft diameter was determined according to the criteria of the Lansac group, based on the aortic annulus diameter. The free margin of the leaflet was treated with central plication based on a standard (target length of the free margin of the leaflet = the diameter of the selected graft + 3 5 mm). The surgery was successfully completed in all 12 patients, with no hospital deaths or complications. Four patients required central plication of the free margin of three leaflets, two required treatment of two leaflets, three required treatment of one leaflet, and three did not require treatment of the free margin of the leaflet. No more than mild degree of residual aortic regurgitation was observed postoperatively. After reconstruction of the aortic root, the measured effective height and coaptation length were 8.9 ± 1.3 mm and 5.3 ± 0.9 mm, respectively. A guiding strategy based on the diameter of the selected graft can be effectively used to manage the length of the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring.

To investigate the effects of transcatheter heart valve (THV) poses and bicuspid aortic valve (BAV) subtypes on coronary hemodynamics after transcatheter aortic valve replacement (TAVR). The computational models for BAV included left-right fusion (LR), non-coronary-left fusion (LN) and non-coronary-right fusion (RN). THV deployment height is defined as the distance below the aortic annulus of the lowest point of the stent, H1 ​= ​2 ​mm, H2 ​= ​5 ​mm and H3 ​= ​8 ​mm, Orientations include O1 (one commissure is aligned with the raphe) and O2 (one commissure is aligned with the axis of non-fused leaflet symmetry). The maximum flow velocity (Vmax), mean wall shear stress (mWSS) and coronary perfusion pressure (CPP) of coronary were obtained by computational fluid dynamics (CFD) simulation. The CPP was 59% in left coronary and 82% in right coronary higher than that before deployment. At O1, the CPP of the LN left coronary and the RN right coronary was 74% and 79% higher than that before deployment. At O2, the CPP of the LN right coronary and the RN left coronary was 83% and 82% higher than that before deployment. When the THV deployment height is less than 2 ​mm, Vmax and CPP of coronary arteries do not return to healthy TAV levels or changed weakly. The overlap of the THV commissure with the coronary ostium makes the coronary CPP so large that it exceeds the level of a healthy TAV.

Leaflet durability and costs restrict contemporary trans-catheter aortic valve replacement (TAVR) largely to elderly patients in affluent countries. TAVR that are easily deployable, avoid secondary procedures and are also suitable for younger patients and non-calcific aortic regurgitation (AR) would significantly expand their global reach. Recognizing the reduced need for post-implantation pacemakers in balloon-expandable (BE) TAVR and the recent advances with potentially superior leaflet materials, a trans-catheter BE-system was developed that allows tactile, non-occlusive deployment without rapid pacing, direct attachment of both bioprosthetic and polymer leaflets onto a shape-stabilized scallop and anchorage achieved by plastic deformation even in the absence of calcification. Three sizes were developed from nickel-cobalt-chromium MP35N alloy tubes: Small/23 mm, Medium/26 mm and Large/29 mm. Crimp-diameters of valves with both bioprosthetic (sandwich-crosslinked decellularized pericardium) and polymer leaflets (triblock polyurethane combining siloxane and carbonate segments) match those of modern clinically used BE TAVR. Balloon expansion favors the wing-structures of the stent thereby creating supra-annular anchors whose diameter exceeds the outer diameter at the waist level by a quarter. In the pulse duplicator, polymer and bioprosthetic TAVR showed equivalent fluid dynamics with excellent EOA, pressure gradients and regurgitation volumes. Post-deployment fatigue resistance surpassed ISO requirements. The radial force of the helical deployment balloon at different filling pressures resulted in a fully developed anchorage profile of the valves from two thirds of their maximum deployment diameter onwards. By combining a unique balloon-expandable TAVR system that also caters for non-calcific AR with polymer leaflets, a powerful, potentially disruptive technology for heart valve disease has been incorporated into a TAVR that addresses global needs. While fulfilling key prerequisites for expanding the scope of TAVR to the vast number of patients of low- to middle income countries living with rheumatic heart disease the system may eventually also bring hope to patients of high-income countries presently excluded from TAVR for being too young.

目的 探讨经股动脉经导管主动脉瓣置换术(TAVR)治疗主动脉瓣单纯关闭不全的临床疗效和术前评估要点.方法 回顾性分析阜外医院2019年5月至2020年10月行经股动脉TAVR 129例患者的临床资料,其中男83例、女46例,平均年龄(72.26±8.97)岁.根据疾病情况分为单纯主动脉瓣关闭不全组(17例)和主动脉瓣狭窄组(112例).分析主动脉根部形态学特点、手术有效性及安全性.结果 单纯主动脉瓣关闭不全组与主动脉瓣狭窄组比较,3MENSIO测量的瓣环[(25.75±2.21)mm vs.(24.70±2.90)mm,P=0.068]及流出道直径[(25.82±3.75)mm vs.(25.37±3.92)mm,P=0.514]差异无统计学意义.单纯主动脉瓣关闭不全组与主动脉瓣狭窄组相比,瓣中瓣发生率较高(47.0％vs.16.1％,P＜0.01).中转外科手术、术中使用体外循环辅助、术中左室破裂、术后使用体外膜肺氧合辅助、术后外周血管并发症、术后致残性脑卒中、死亡、术后起搏器植入两组差异无统计学意义.结论 单纯主动脉瓣关闭不全患者行经股动脉TAVR可行.术前应重点评估瓣环平面直径、流出道直径以及流出道的形态.

目的 探讨经导管主动脉瓣置换术(TAVR)在中国老年主动脉瓣狭窄(AS)患者中的安全性和有效性.方法 选取行手术治疗的AS患者132例,其中行外科主动脉瓣置换术(SAVR)手术患者8例(SAVR组);行TAVR手术患者124例(TAVR组).观察两组围术期临床结果.结果 围术期内出现1例(0.76％)死亡及1例(0.76％)医源性主动脉夹层,发生于SAVR组,与TAVR组比较有显著差异(P<0.01).其他并发症:致残性的脑卒中1例(0.76％),外周血管并发症2例(1.51％),术中左室破裂1例(0.76％),术后起搏器植入10例(7.60％),均发生于TAVR组,两组比较无显著统计学差异(P>0.05).结论 TAVR治疗老年AS是安全和有效的.

目的 探讨经导管主动脉瓣置换术(TAVR)治疗二叶式主动脉瓣狭窄的临床疗效和术前评估要点.方法 纳入阜外医院2020年1月～2020年12月完成的TAVR患者54例.分析主动脉根部形态学特点、手术有效性及安全性.结果 三组瓣膜选择的oversize(测量瓣环直径/选择瓣环直径-1)为:-0.22±8.62％vs.0.53±8.37％vs.8.02±6.71％.三叶瓣组与功能二叶瓣组及解剖二瓣化组相比,3mensio测量的瓣环的平均直径、流出道平均直径、窦管交界平均直径和升主动脉平均直径数值均较小,有显著的统计学差异(P＜0.01);左右冠的开口高度及右窦的大小数值均较小(P＜0.05).中转外科手术、术中再次置入瓣膜、术中使用体外循环辅助、术中左室破裂、术后使用ECMO辅助、术后外周血管并发症、术后致残性脑卒中、死亡、术后起搏器植入和术后冠脉栓塞三组间比较无明显统计学差异.结论 经导管主动脉瓣置换术对于二叶瓣的主动脉瓣狭窄的治疗是安全和有效的.术前CT的评估有着重要的意义.二叶瓣的瓣膜的选择建议downsize,解剖二叶瓣建议较大程度的downsize.

Objective:To summarize the research progress on the use of the descending branch of the lateral femoral circumflex artery (DBLCFA) in coronary artery bypass grafting.Methods:Thirty related articles were obtained by keyword search using the terms,"旋股外侧动脉降支""冠状动脉旁路移植术""心肌血运重建""全动脉化""解剖"and"coronary artery bypass grafting""descending branch of the lateral circumflex femoral artery""cardiovascular reconstruction""total arterial revascularization"in CNKI, and Wanfang data and PubMed from January 1996 to November 2020. The use of the DBLCFA in coronary artery bypass grafting was also analyzed and summarized based on the clinical experience of our center.Results:Anatomically, DBLCFA has accessible length and matches the vascular diameter of target coronary arteries. Histologically, it has anti-atherosclerosis stability. DBLFCA shows a satisfactory patency rate in mid-term follow-up; thus, it is a reliable choice of artery material in myocardial revascularization.Conclusions:DBLCFA has good clinical application value as a coronary artery bypass graft material and is technically safe and feasible with good medium-term outcomes and low incidence of complications. However, its long-term application effect needs to be further evaluated.

目的 探讨经导管主动脉瓣置换术治疗高龄主动脉瓣狭窄患者的有效性和安全性.方法 回顾性分析2019年1月至2020年12月于中国医学科学院阜外心血管病医院行TAVR手术的主动脉瓣狭窄患者142例.其中年龄≥80岁患者22例为高龄老年组,65≤年龄<80岁患者120例为老年组,比较2组围手术期结果.采用SPSS 20.0软件进行统计学分析.根据数据类型,组间比较分别采用χ2检验、t检验或者Fisher精确检验.结果 高龄老年组和老年组中转外科手术发生率(0.0％和1.7％)、术中使用体外循环辅助率(0.0％和0.8％)、术中左室破裂发生率(0.0％和0.8％)、术后使用体外膜肺氧合辅助循环率(0.0％和1.7％)、术后外周血管并发症(0.0％和3.3％)、术后起搏器植入率(4.5％和8.3％)、术后致残性脑卒中(0.0％和0.8％)、围术期死亡发生率(0.0％和0.8％),差异均无统计学意义(均P>0.05).非股动脉入路患者共6例(4.2％),其中老年组左侧锁骨下动脉入路1例(0.7％),升主动脉入路1例(0.7％),经颈动脉入路3例(2.5％);高龄老年组经颈动脉入路1例(4.5％),差异均无统计学意义(均P>0.05).结论 经导管主动脉瓣置换术是治疗高龄的主动脉狭窄患者的有效及安全的治疗方法.

目的 探讨经导管主动脉瓣置换术(TAVR)治疗心功能衰竭主动脉瓣狭窄患者的有效性和安全性.方法 回顾性分析阜外医院2019年1月至2020年12月行TAVR手术的主动脉瓣狭窄患者142例.根据左心室射血分数(LVEF)将患者分为三组,其中重度心功能衰竭(LVEF≤30)组6例(6/142,4.2％),中度心功能衰竭(31≤LVEF≤49)组33例(33/142,23.2％),正常心功能(LVEF≥50)组103例(103/142,72.5％).结果 围手术期内共有2例(2/142,1.4％)患者中转外科手术,重度心功能衰竭组1例(1/6,17％),中度心功能衰竭组1例(1/19,3.0％),有显著的统计学差异(P＜0.01).术后使用体外膜肺氧合(ECMO)辅助循环2例(2/142,1.4％),重度心功能衰竭组1例(1/6,17％),中度心功能衰竭组1例(1/19,3.0％),有显著的统计学差异(P＜0.01).术中使用体外循环辅助1例(1/42,0.70％),死亡1例(1/142,0.70％),均发生于中度心功能衰竭组;术中左室破裂1例(1/142,0.70％),术后致残性卒中1例(1/142,0.70％),均发生于正常心功能组;三组无明显的统计学差异.术后外周血管并发症4例(4/142,2.8％),术后起搏器置入11例(11/142,7.7％),三组无明显的统计学差异.结论 经导管主动脉瓣置换术是治疗心功能衰竭的主动脉狭窄患者的有效和安全的治疗方法.

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications. Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation. Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19). Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

目的 观察经升主动脉入路行经导管主动脉瓣置入术(transcatheter aortic valve implantation,TAVI)的安全性及可行性.方法 2012年11月至2019年12月阜外医院行经升主动脉动脉路径TAVI患者共14例,男6例,女8例.统计其手术成功率、围术期并发症、血流动力学改善情况以及主要心脏不良事件的发生情况.结果 患者平均年龄为(75.6±7.4)岁.7例行经胸骨上段切口,另外7例行经右侧胸骨旁切口.14例患者经升主动脉行TAVI全部成功,无围术期死亡发生.围术期主要并发症包括:术中转正中开胸探查止血1例(7.1％),术后起搏器植入2例(14.3％),术后二次开胸探查止血1例(7.1％).与术前相比,患者的左室射血分数在术后1个月有明显的提高(52.11±12.88与62.03±6.57,P=0.019).结论 严重外周血管病变不能经股动脉行TAVI患者,经升主动脉路径手术是安全可行的.

目的 探讨Venus-A支架瓣膜行经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者的可行性.方法 回顾性调阅2018年12月至2019年12月在阜外医院接受经股动脉经导管主动脉瓣置换术的15例单纯主动脉瓣关闭不全患者的临床资料.其中男性12例、女性3例,年龄68～83岁,平均(74.65±5.52)岁.患者术前均有左心功能不全症状,且术前超声心动图诊断均为单纯主动脉瓣重度反流.结果 患者行经股动脉经导管主动脉瓣置换术.所有病例成功置入Venus-A支架瓣膜.全组病例无死亡.出院前对患者进行临床评估和超声心动图检查.术中行瓣中瓣治疗3例,少量瓣周反流2例.其余患者均无明显瓣周反流,并且顺利出院.结论 经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者是可行的,术后早期结果 满意.

Objective:To explore the clinical application of Fuwai aortic dissection classification, including comparing the difference between the diverse types, and its meaning of aortic surgery selection.Methods:Retrospectively collected 1 570 aortic dissection surgery patients from January 1, 2010 to December 31, 2015 in Fuwai Hospital. Fuwai classification includes four types. Type A restricted to the ascending aorta. Type B refers to the descending aorta dissection below the left subclavian artery. Type C refers to dissection involve the aortic arch. Type D refers to the dissection restricted to the abdominal aorta below the diaphragm. The subtype of the type C include type Cp, type Ct and type Cd. Type Cp refers to the proximal aortic arch is involved (at least the left subclavian artery was not implicated). Type Ct refers to total aortic arch is involved. Type Cd refers to the distal aortic arch is involved (at least the innominate artery was not implicated). We compared the differences among the four types (A/B/C/D) and three subtypes (Cp/Ct/Cd) aortic dissection in preoperative, intro and postoperative characteristics.Results:There were 78 cases (4.96%) Fuwai type A, 421 cases (26.82%) Fuwai type B, 1063 cases (67.71%) Fuwai type C, and 8 cases (0.51%) Fuwai type D. The operative mortality was 5.41%. The average age of the patients in type D was the oldest, which was (58.02 ± 11.93) years. The preoperative renal insufficiency in type C was the highest, (14.96%). Type A had the largest aortic sinus diameter (45.92 ± 12.88 mm). Type C had the highest mortality(7.71%), followed by 0.71% of type B, and no surgical deaths occurred in type A and type D. Among type C patients, 54 patients were type Cp, 832 patients were type Ct, 177 patients were type Cd. Surgery mortality between type Ct and type Cd was significant difference (9.38% vs. 1.69%, P<0.01). Type Ct had higher surgery mortality than type Cp, there was no difference (9.38% vs. 1.85%, P=0.06). Type Cp and type Cd had no significant statistical difference in surgical mortality (1.85% vs. 1.69%, P=0.94). Simply ascending aorta replacement accounted for 64.1% in type A , TEVAR accounted for 81.53% in type B , partial arch replacement accounted for 62.96% in type Cp, total aortic arch replacement accounted for 98.56% in type Ct, debranch+ TEVAR/TEVAR accounted for 70.62% in type Cd, EVAR accounted for 100% in type D. Conclusion:The Fuwai classification is more comprehensive and practical for clinical application than the traditional classification. Different classification had different clinical characteristics and prognosis. The classification was helpful for surgical methods selection.

目的 应用倾向得分匹配法分析旋股外动脉降支(DBLCFA)和桡动脉(RA)进行体外循环下冠状动脉旁路移植治疗稳定性冠心病的预后和影响因素.方法 本研究为前瞻性队列研究.收集自2017年1月至2019年6月在阜外医院行体外循环下冠状动脉旁路移植术的稳定性冠心病患者,依据倾向评分匹配法按1:3选取52例应用旋股外动脉作为桥血管的患者作为DBLCFA组和156例应用桡动脉作为桥血管的患者作为RA组,随访截止时间为2019年12月31日,比较两组的临床资料,Kaplan-Meier生存分析和log-rank检验比较两组的桥血管通畅率和不良心血管事件(MACE)发生率,单因素和多因素Cox回归分析影响预后的危险因素.结果 208例稳定性冠心病患者中,平均年龄(54.7±15.5)岁(40～70岁).DBLCFA组和RA组患者的年龄、体质指数、病史和危险因素、实验室检查、冠心病严重程度等均无明显差异(均P>0.05).Kaplan-Meier生存分析结果显示,随访1年后,DBLCFA组桥血管通畅率为96.2％(50/52),生存率为98.1％(51/52),MACE发生率为5.8％(3/52);RA组桥血管通畅率为97.4％(152/156),生存率为100.0％(156/156),MACE发生率为5.1％(8/156),两组间的桥血管通畅率(χ2=0.228,P=0.632)、存活率(χ2=3.014,P=0.083)和MACE发生率(χ2=0.032,P=0.862)均无明显差别.随访3年后,DBLCFA组桥血管通畅率为90.4％(47/52),生存率为94.2％(49/52),MACE发生率为14.3％(7/52);RA组桥血管通畅率为93.6％(146/156),生存率为98.1％(153/156),MACE发生率为10.9％(17/156).两组间的桥血管通畅率(χ2=0.598,P=0.439)、存活率(χ2=2.059,P=0.151)和MACE发生率(χ2=0.251,P=0.8616)均无明显差别.多因素Cox回归分析结果显示,年龄(HR=2.425,95％CI:1.286～4.573,P=0.006)、EuroscoreⅡ评分(HR=2.463,95％CI:1.116～5.436,P=0.026)和糖尿病(HR=3.024,95％CI:1.427～6.408,P=0.004)是影响MACE的危险因素.结论 对稳定性冠心病患者,DBLCFA作为移植血管具有较高的早中期通畅率、存活率和较低的MACE发生率,是一支良好的冠状动脉旁路移植血管.

Background. This study evaluated the short- and middle-term outcomes of different aortic root managements in the setting of acute type A aortic dissection (ATAAD): aortic root repair (ARR group), untouched aortic root (UAR group), and Bentall procedure (Bentall group). Methods. The study enrolled 673 patients (512 men; age 48.8 +/- 11.2 years) between 2010 and 2015. Survival, aortic growth, reintervention, and valve function were compared between the 3 groups. Results. The ages were 50.6 +/- 9.9, 49.8 +/- 12.2, and 44.0 +/- 12.0 years for ARR, UAR, and Bentall groups, respectively (P <.01). The mean follow-up time was 3.0 years (range, 0.5-6.8 years). The aortic root diameters in the groups were 39.0 +/- 5.1 mm in ARR, 38.2 +/- 4.4 mm in UAR, and 50.3 +/- 6.2 mm in Bentall (P <.01). The overall 30-day mortality was 11.7% (79 of 673). There was no difference in 30-day mortality between the 3 groups (P = .58). The estimated aortic root growth rate was 0.60 +/- 0.17 mm/y for ARR and 0.50 +/- 0.14 mm/y for UAR. During follow-up, 28 patients (4.1%) died. Differences in 5-year survival between the 3 groups did not reach statistical significance (P = .82). Aortic insufficiency greater than grade 2D developed in 15 patients (2.2%). There was no significant difference between ARR and UAR in freedom from aortic insufficiency greater than grade 2D(P= .56). None of the patients experienced new dissection or underwent proximal reoperation during the follow-up period. Conclusions. Conservative techniques (ARR and UAR) and aggressive root replacement can both be performed with excellent short- and middle-term outcomes in ATAAD. Thus, an individualized approach in managing the aortic root for ATAAD is recommended based on the patient's general condition, root pathology, and the surgeon's preference. (C) 2020 by The Society of Thoracic Surgeons