Heart, Lung and Circulation最新文献

Aim: Bicuspid aortic valve (BAV) is a common congenital heart defect often associated with ascending aorta dilation. Current guidelines suggest surgical intervention for diameters ≥45 mm in conjunction with surgical aortic valve replacement (SAVR). However, the optimal management of ascending aortas measuring 40-44 mm remains under debate. This study aims to evaluate the evolution of aortic diameter in patients with BAV and ascending aorta diameters between 40 and 44 mm undergoing aortic valve replacement, assessing whether a conservative approach is justified.

Method: We conducted a retrospective observational study, analysing 88 patients with BAV who underwent SAVR between January 2012 and December 2018. Patients were divided into two groups based on preoperative ascending aorta diameters: <40 mm (Group 1, n=15) and the ≥40 and <45 mm (Group 2, n=11). Follow-up of at least 5 years included aortic dilation rates, survival, and reoperation rates.

Results: No significant differences were observed in aortic dilation between the two groups during follow-up, with overall annual dilation rates of 0.2±0.07 mm/year. Survival rates were 86.3% for Group 1 and 81.9% for Group 2, with no reoperations required in either group.

Conclusions: Patients with BAV and ascending aorta diameters of 40-44 mm do not require prophylactic aortic replacement during AVR, provided they undergo regular follow-up. These findings support current guidelines advocating conservative management for ascending aorta diameters in this range. However, in younger patients or those nearing the 45 mm threshold, surgical replacement may still be considered to pre-empt future complications.

Background: It is unknown if internal mammary artery (IMA), radial artery (RA), or saphenous vein grafts (SVGs) supplying chronic total occlusion (CTO) coronary arteries exhibit increased failure over time compared with non-CTO targets.

Methods: Patients underwent predominantly symptom-indicated coronary angiography between 1997 and 2020 at the Royal Melbourne Hospital, after coronary artery bypass grafting. The primary outcome was the graft failure rate of IMA, RA, and SVGs with a CTO target compared with a non-CTO target, with failure additionally compared between conduits with a CTO target. Analysis was performed with an exchangeable generalised estimating equations multivariable binary logistic regression model.

Results: Overall, 313 patients had one or more CTO and 434 patients had only non-CTO targets, with follow-up at 8.7±5.6 years post-procedure. Grafts with CTO targets included 113 IMA, 240 RA, and 66 SVGs; grafts with non-CTO targets included 760 IMA, 940 RA, and 172 SVGs. IMA graft failure was less frequent with a CTO target than a non-CTO target; 0.9% vs 6.3% (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.03-0.82; p=0.029). RA graft failure was also less frequent with a CTO target than a non-CTO target; 3.8% vs 14.4% (OR 0.19; 95% CI 0.09-0.40; p<0.001). In the case of SVGs, failure with a CTO vs non-CTO target was similar; 28.8% vs 19.8% (OR 1.06; 95% CI 0.30-3.76; p=0.932). Of grafts with a CTO target, failure was greater for SVGs than for arterial grafts; 28.8% vs 2.8% (OR 10.38; 95% CI 3.71-29.04; p<0.001), whereas failure was not different between IMA and RA grafts; 0.9% vs 3.8% (OR 0.45; 95% CI 0.10-2.02; p=0.297).

Conclusion: Internal mammary and RA grafts had lower graft failure rates in the late term than SVGs when applied to CTO targets.