Gulbins H, Kreuzer E, Uhlig A, Reichart B
Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Germany.
J Heart Valve Dis. 2001 Sep;10(5):650-5.
In patients with aneurysms or dissections of the ascending aorta and additional aortic valve disease, valve-containing composite grafts are used in clinical routine. The study aim was to present our experience with homografts for aortic valve replacement extended by a vascular prosthesis as an alternative to the classical Bentall procedure.
Thirty consecutive patients (mean age 46+/-14 years) were included in this study. Indications for valve replacement were aortic stenosis (n = 15), aortic insufficiency (n = 6), combined aortic valve disease (n = 6), endocarditis of the native valve (n = 1), and endocarditis of a previously placed bioprosthesis (n = 2). The mean diameter of the ascending aorta was 5.6+/-0.5 cm; one patient had an acute dissection (diameter 4.4 cm). For valve replacement, cryopreserved homografts (mean size 24+/-2 mm) were used in a mini-root technique, and the ascending aorta was replaced by collagen-coated vascular prostheses (mean diameter 28+/-3 mm). The size of the vascular prosthesis was adjusted to the diameter of the sinutubular junction of the implanted homograft. Follow up included annual clinical examinations, transthoracic echocardiography and ultrafast computed tomography (CT) scans.
All patients survived surgery, and no deaths occurred during follow up. None of the patients had postoperative anticoagulation, and no thromboembolic events were noted. Follow up was complete, with an average 48 months (range: 6 to 84 months). Doppler echocardiography revealed trivial to mild aortic regurgitation in nine patients postoperatively, with no deterioration during follow up. No pathologic pressure gradients over the aortic valves were measured at Doppler echocardiography; the mean valvular orifice area was 2.5+/-0.3 cm2. At ultrafast CT, normal homograft anatomy including the sinotubular junction, no calcifications, and no signs of annular dilatation were seen. In the patient who had surgery for acute endocarditis of the native valve, ultrafast CT revealed a small pseudoaneurysm below the left coronary artery, without need for reoperation.
Short- and mid-term results show that cryopreserved homografts extended by small-sized vascular prostheses can be used safely for Bentall procedures in selected cases where the diameter of the aortic valve annulus is moderately dilated.
对于升主动脉瘤或夹层合并其他主动脉瓣疾病的患者，临床常规使用含瓣膜的复合移植物。本研究的目的是介绍我们使用带血管假体延长的同种异体移植物进行主动脉瓣置换的经验，作为经典Bentall手术的替代方法。
本研究纳入了30例连续患者（平均年龄46±14岁）。瓣膜置换的适应证包括主动脉瓣狭窄（n = 15）、主动脉瓣关闭不全（n = 6）、主动脉瓣联合病变（n = 6）、自体瓣膜心内膜炎（n = 1）以及先前植入的生物假体心内膜炎（n = 2）。升主动脉的平均直径为5.6±0.5 cm；1例患者为急性夹层（直径4.4 cm）。对于瓣膜置换，采用小根部技术使用冷冻保存的同种异体移植物（平均尺寸24±2 mm），升主动脉用胶原涂层血管假体（平均直径28±3 mm）置换。血管假体的尺寸根据植入的同种异体移植物的窦管交界处直径进行调整。随访包括每年的临床检查、经胸超声心动图和超速计算机断层扫描（CT）。
所有患者均存活至手术，随访期间无死亡发生。所有患者术后均未进行抗凝治疗，未观察到血栓栓塞事件。随访完整，平均48个月（范围：6至84个月）。多普勒超声心动图显示9例患者术后有轻微至轻度主动脉瓣反流，随访期间无恶化。多普勒超声心动图未测得主动脉瓣上的病理性压力阶差；平均瓣膜口面积为2.5±0.3 cm²。在超速CT检查中，可见正常的同种异体移植物解剖结构，包括窦管交界处，无钙化，无瓣环扩张迹象。在因自体瓣膜急性心内膜炎接受手术的患者中，超速CT显示左冠状动脉下方有一个小假性动脉瘤，无需再次手术。
短期和中期结果表明，在主动脉瓣环直径中度扩张的特定病例中，带小尺寸血管假体延长的冷冻保存同种异体移植物可安全用于Bentall手术。
