Jin X Y, Westaby S
Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, England.
Semin Thorac Cardiovasc Surg. 1999 Oct;11(4 Suppl 1):145-50.
The goal of this study was to characterize medium-term changes in aortic root geometry after stentless aortic valve replacement, the relationship between aortic sinotubular junction and the competence of stentless valves. A total of 205 consecutive patients (mean age 73+/-6 years; 120 men, 85 women) received a Freestyle stentless porcine aortic valve and were studied prospectively by echocardiography from 1 week to 5 years. Internal diameters of outflow tract, annulus, sinus, sinotubular junction, and ascending aortic root were measured at early ejection and indexed to stentless valve size. The degree of stentless valve regurgitation was semiquantified by color Doppler echocardiography. A total of 701 echocardiographic studies were obtained and analyzed; 73% showed a fully competent stentless valve (nAR) and 13% and 14%, respectively, showed a trivial (tAR) or mild (mAR) regurgitation. Sinotubular junction of tAR or mAR was significantly greater than that of nAR (111+/-1.9, 117+/-2.2 vs. 104+/-1.0, percentage of valve size, P<.001). A preoperative diagnosis of aortic regurgitation (110+/-2.6 vs. 104+/-1.0, percentage of valve size, P<.001) and 4 to 5-year follow-up time (116+/-2.2 vs. 107+/-2.9, percentage of valve size, P = .023) were associated with a greater sinotubular junction, although the incidence and mean grade of stentless valve regurgitation did not change significantly during the follow-up period. Up to medium-term follow-up evaluation, the incidence of moderate stentless aortic regurgitation is less than 5%. The nature of valve disease and age-related increase in sinotubular junction may have reduced the cusp coaptation area of the stentless valve and may predict the presence of a trivial or mild regurgitation. Understanding the interrelations between the stentless valve and remodeling of the aging aorta has important implications for both surgical technique and long-term follow-up outcome.
本研究的目的是描述无支架主动脉瓣置换术后主动脉根部几何形态的中期变化，以及主动脉窦管交界与无支架瓣膜功能之间的关系。共有205例连续患者（平均年龄73±6岁；男性120例，女性85例）接受了Freestyle无支架猪主动脉瓣，并在术后1周~5年通过超声心动图进行前瞻性研究。在射血早期测量流出道、瓣环、窦部、窦管交界和升主动脉根部的内径，并根据无支架瓣膜大小进行校正。通过彩色多普勒超声心动图对无支架瓣膜反流程度进行半定量分析。共获得并分析了701次超声心动图检查结果；73%显示无支架瓣膜功能完全正常（nAR），13%和14%分别显示微量（tAR）或轻度（mAR）反流。tAR或mAR组的窦管交界显著大于nAR组（分别为111±1.9、117±2.2与104±1.0，占瓣膜大小的百分比，P<0.001）。术前诊断为主动脉反流（110±2.6与104±1.0，占瓣膜大小的百分比，P<0.001）以及4至5年的随访时间（116±2.2与107±2.9，占瓣膜大小的百分比，P = 0.023）与更大的窦管交界相关，尽管在随访期间无支架瓣膜反流的发生率和平均分级没有显著变化。直至中期随访评估，中度无支架主动脉反流的发生率小于5%。瓣膜疾病的性质以及与年龄相关的窦管交界增大可能减少了无支架瓣膜的瓣叶对合面积，并可能预示微量或轻度反流的存在。了解无支架瓣膜与衰老主动脉重塑之间的相互关系对于手术技术和长期随访结果均具有重要意义。
