Eliminating left ventricular outlet stenosis lowers the risk for endocardial fibroelastosis recurrence

作者：Gregor Gierlinger, Daniel Diaz‐Gil, Andreas Tulzer, R. Mair, Eva Sames-Dolzer, Kerstin Saraci, Steven J. Staffa, David Zurakowski, Michaela Kreuzer, Fabian Seeber, Sitaram M Emani, Pedro J. del Nido, Rudolf Mair, Ingeborg Friehs · 发表于：European Journal of Cardio-Thoracic Surgery · 年份：2025 · DOI：10.1093/ejcts/ezaf214 · 被引用次数：2 · 研究领域：Congenital Heart Disease Studies、Cardiac Valve Diseases and Treatments、Aortic Disease and Treatment Approaches

OBJECTIVES: Patients with endocardial fibroelastosis (EFE) in the setting of congenital critical aortic valve (AoV) stenosis and left ventricular outflow tract obstruction (LVOTO) are at risk for diastolic dysfunction, limiting biventricular circulation. EFE resection is the only available treatment option, but frequently recurs requiring re-resections. We aimed to investigate whether augmentation of a left ventricular outlet stenosis (AoV stenosis ± LVOTO) with a Ross/Ross-Konno procedure prevents EFE recurrence. METHODS: Patients born with AoV stenosis ± LVOTO and treated with primary left ventricular (LV) EFE resection at the study centres from January 2010 to December 2021 were included in the study. The inclusion criteria for this retrospective analysis was the presence or absence of a Ross/Ross-Konno procedure for the treatment of a modifiable risk factor of EFE recurrence. Retrospective allocation to either the non-Ross or Ross/Ross-Konno group was carried out accordingly. The primary outcome measure was EFE recurrence. RESULTS: Ninety-three patients were screened, and 60/93 patients (64.5%) met all inclusion criteria. Within those 60 patients, 5/23 (20.7%) in the Ross/Ross-Konno group had EFE recurrence compared to 23/37 (62.2%) in the non-Ross group [difference = 40.5%, 95% confidence interval (CI) 14.6-58.7, P = 0.003] and were less likely to develop EFE recurrence with adjusted hazard ratio of 4.07 (95% CI 1.38-12.0, P = 0.011) and 3.69 (95% CI 1.31-10.42, P = 0.01...