Surgical Treatment Of Aortic Valve Disease Combined With Ascending Aortic Dilatation In Patients With Non Marfan Syndrome

Objective: To observe the postoperative changes of aortic valve disease combined with ascending aortic dilatation;To explore the selection of surgical procedures for patients with aortic valve disease combined with ascending aortic dilatation(40-50mm)and compare the quality of life of patients after different surgical procedures.Methods: Retrospective analysis of patients who needed surgery due to aortic valve disease combined with ascending aortic dilatation(40-50mm)in Guizhou Provincial People’s Hospital from April 2017 to June 2021.Excluding patients with "Marfan syndrome" and "aortic dissection",43 patients were enrolled,the data of 3 patients were lost and incomplete,and 40 patients were finally enrolled.According to the surgical procedure,the patients included in the study were divided into simple aortic valve replacement(AVR)group(n=16),AVR simultaneous ascending aortic plasty group(n=12)and AVR simultaneous ascending aortic replacement group(n=12).Collect all the selected patients’ names,gender,age,complications,aortic valve morphology(bicuspid or trivalvular),type of aortic valve disease,left ventricular ejection fraction,preoperative and postoperative diameter of ascending aorta,aortic valve calcification,cardiopulmonary bypass time,aortic occlusion time,early postoperative complications,other operations in the same period,follow-up time Short term quality of life scale and other clinical data.The clinical data of the three groups were compared between groups or within groups,and the changes of ascending aorta diameter and expansion rate before and after operation and different intervention patients were compared.Results: There was statistically significant difference in aortic occlusion time and cardiopulmonary bypass time among the three groups(P<0.05);the final results showed that compared with the simple AVR group,aortic occlusion time and cardiopulmonary bypass time in the AVR simultaneous ascending aorta plasty group and AVR simultaneous ascending aortic replacement group increased significantly(P<0.05).There was no significant difference in the incidence of postoperative hemorrhage,poor incision healing,pulmonary related diseases(pneumothorax,pleural effusion,pulmonary infection),renal insufficiency,pericardial effusion and postoperative atrial flutter among the three groups(P>0.05);the follow-up time of the three groups was not statistically significant(P>0.05).The diameter of aorta was significantly different from that before operation(P<0.05);In the simple AVR group,there were 4 cases with different degrees of further expansion of the diameter of the ascending aorta,and only 1 case(6.2%)was followed up to 55 mm.There were no adverse events of aorta and aortic surgery in the three groups during postoperative follow-up;there was no significant difference in aortic dilatation rate among the three groups;there was no significant difference in the scores of quality of life scale among the three groups(P>0.05).Conclusion: For the surgical treatment of patients with non Marfan syndrome aortic valve disease combined with ascending aorta diameter of 40-50 mm,simple aortic valve replacement,simultaneous ascending aortic angioplasty or replacement can achieve better treatment results.The surgical scheme should be determined according to the specific conditions of patients,but single AVR or relatively simple angioplasty can be selected.In the future,it needs the support of long-term follow-up results of multiple centers and multiple cases.