Pethig Klaus, Milz Andrea, Hagl Christian, Harringer Wolfgang, Haverich Axel
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany.
Ann Thorac Surg. 2002 Jan;73(1):29-33. doi: 10.1016/s0003-4975(01)03312-4.
Aortic root reconstruction by reimplantation of the native valve represents a new therapeutic option for ascending aortic aneurysms. Information about long-term follow-up is limited, and possible predictors for failure of reconstruction have not been evaluated so far.
After aortic valve reimplantation 101 patients were followed in a prospective observational study. From this cohort the first 75 consecutive patients with a complete 1-year follow-up were chosen for further analysis. Clinical and echocardiographic data were obtained preoperatively, intraoperatively, and early postoperatively, as well as after 1 year of follow-up.
No mortality was observed within the first 30 days. There were 52 male patients, mean age was 49.1+/-20.6 years, observation period was 35.6+/-20.6 months, and Marfan's syndrome was present in 22 patients. Although in 67 patients a stable valve function could be demonstrated, 5 patients presented with mild aortic insufficiency or had to be operated on again for secondary valve failure (n = 3). Analyzing possible demographic, disease-related, and procedure-related risk factors in a multivariable approach, only level of coaptation within the graft (as assessed by echocardiography) could be identified as being related to the subsequent development of aortic insufficiency. Coaptation level within the tube graft (type A) resulted in a mean aortic regurgitation grade of 0.3+/-0.5 as compared with a mean grade of 2.5+/-0.6 for a coaptation type C (below the prosthesis; p < 0.001).
Aortic valve reimplantation is a promising alternative to alloprosthetic composite replacement. A level of coaptation within the tube graft is essential to achieve valve competence.
通过原位瓣膜再植入进行主动脉根部重建是治疗升主动脉瘤的一种新的治疗选择。关于长期随访的信息有限，且迄今为止尚未评估重建失败的可能预测因素。
在主动脉瓣再植入术后，对101例患者进行了前瞻性观察研究。从该队列中选取了连续75例有完整1年随访的患者进行进一步分析。术前、术中、术后早期以及随访1年后均获取了临床和超声心动图数据。
术后30天内未观察到死亡病例。有52例男性患者，平均年龄为49.1±20.6岁，观察期为35.6±20.6个月，22例患者患有马凡综合征。尽管67例患者的瓣膜功能稳定，但5例患者出现轻度主动脉瓣关闭不全或因继发性瓣膜功能衰竭而需再次手术（n = 3）。采用多变量方法分析可能的人口统计学、疾病相关和手术相关风险因素，仅移植物内的对合水平（通过超声心动图评估）可被确定与随后的主动脉瓣关闭不全的发生有关。与C型对合（假体下方）的平均反流分级2.5±0.6相比，管型移植物（A型）内的对合水平导致平均主动脉反流分级为0.3±0.5（p < 0.001）。
主动脉瓣再植入是同种异体复合置换的一种有前景的替代方法。管型移植物内的对合水平对于实现瓣膜功能至关重要。
