VSRR手术与Bentall手术近期疗效的安全性评价:倾向性评分匹配对比的应用

Comparative study of valve sparing aortic root replacement(VSRR)procedure and Bentall procedure:A propensity score matching study

目的利用倾向性评分匹配对比法均衡保留瓣叶的主动脉根部置换术（VSRR手术）与带主动脉瓣人工血管升主动脉替换术（Bentall手术）手术治疗的混杂因素,评价2种术式围手术期安全性的差异。方法选取2005年9月—2015年9月在首都医科大学附属北京安贞医院心外科九病房行主动脉根部手术患者186例,其中VSRR手术48例（VSRR组）,Bentall手术138例（Bentall组）,进行Logistic回归计算倾向性评分,利用倾向性评分匹配对比研究的方法,找出与VSRR手术最匹配的48例进行对比研究。根据2组手术的术中、术后数据,评价VSRR手术相对于Bentall手术的安全性和适用性。结果 VSRR组手术时间长于Bentall组[（6.8±1.9）h vs.（5.7±2.1）h,t=2.691,P=0.00],主动脉阻断时间长于Bentall组[（154.4±42.0）min vs.（131.6±46.1）min,t=2.533,P=0.013],驻重症监护室（ICU）时间短于Bentall组[（34.5±38.6）h vs.（37.5±21.1）h,t=0.472,P=0.634],但差异均无统计学意义（P〉0.05）;VSRR组主动脉瓣跨瓣平均压差低于Bentall组[（9.56±6.51）mmHg vs.（13.07±7.53）mmHg,t=2.443,P=0.016],主动脉瓣跨瓣峰值压差低于Bentall组[（18.0±2.11）mmHg vs.（23.37±11.80）mmHg,t=3.104,P=0.003];术后患者超声心动图检查主动脉瓣关闭不全发生率,VSRR组（10.5%）与Bentall组（2.1%）差异亦无统计学意义（χ^2=3.422,P=0.331）;VSRR组病死率（4.2%）低于Bentall组（2.1%）,但差异无统计学意义（χ^2=0.344,P=1.000）,术后并发症（心律失常、二次开胸止血、手术后感染、神经系统并发症、急性肾功能衰竭等）发生率差异无统计学意义（χ^2=0.042,P=0.837）,VSRR组与Bentall组在围手术期生存率与不良事件率差异无统计学意义。结论经倾向性评分匹配对比法均衡后,保留瓣叶的主动脉根部置换手术与带主动脉瓣人工血管升主动脉替换手术在围手术期生存率、不良事件发生率、超声心动图检查等均无明显差异。

Objective Comparison of propensity score matching method is balanced reserves the aortic root replace-ment valve leaflets （ VSRR procedure） and artificial vascular ascending aorta with aortic valve replacement surgery （ Bentall procedure）, surgical treatment of confounding factors, evaluation of the perioperative security of the two groups of patients with surgery.Methods From September 2005 to September 2015, in our hospital, 186 cases of the aortic root disease patients were enrolled, 48 cases including VSRR surgery, Bentall surgery in 138 cases, logistic regression estimation method was used to calculate the propensity score matching score, comparison of propensity score matching research method, find out the best matching of 48 cases with VSRR surgery.By comparing two groups of surgery intra-operative, postoperative results evaluation VSRR surgery compared with Bentall＇s safety and applicability.Results Valve Sparing Aortic Root Replacement （ VSRR） surgery and artificial vascular ascending aorta with aortic valve replacement surgery （ Bentall procedure） in surgical operation time VSRR group （6.8 ±1.9） h and Bentall group （5.7 ±2.1） h （ t =242.36, P =242.36）.Extracorporeal circulation time VSRR group （203.1 ±60.1） min and Bentall group （194.3 ±71.2） min （ t =33.771, P =33.771）, the aorta bloc-king time, VSRR group （154.4 ±42.0） min and Bentall group （131.6 ±46.1） min and （ t =187.76, P =187.76）, in the intensive care unit （ICU） time VSRR group （34.5 ±38.6） and Bentall group （37.5 ±21.1） h, （ t =0.41, P =0.41）.There was no significant difference in such aspects.In the two groups in the aortic valve average pressure differential across the valve VSRR group （9.56 ±6.51） mmHg and Bentall mmHg （13.07 ±7.53）, （ t =67.23, P =67.23）.Aortic average pressure differential across the valve VSRR group （18.0 ±2.11） mmHg and Bentall group （23.37 ±11.8） mmHg, there was statistically difference（ t =124.72, P =124.72）.Postoperative echocardiography in patients with aortic valve a-bove moderate regurgitation VSRR group （2.1%） and Bentall group （0%）.The rest in mortality VSRR group （4.2%） and Bentall （2.1%）, （ t =277.642, P =277.642）, postoperative complications （arrhythmia, secondary bleeding, chest sur-gery mental symptoms of infection, acute renal failure） there was no statistically significant difference in incidence, （ P =0.61）, VSRR and Bentall group in perioperative survival and there was no statistically significant difference between the rate of adverse events.Conclusion After contrast propensity score matching method is balanced, reserve the aortic root replace-ment valve leaflets （ VSRR surgery） and artificial vascular ascending aorta with aortic valve replacement surgery （ Bentall sur-gery） in peri-operative survival and adverse events showed no significant statistical differences in echocardiography.