David Tirone E, Ivanov Joan, Armstrong Susan, Feindel Christopher M, Webb Gary D
Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Ontario, Canada.
Ann Thorac Surg. 2002 Nov;74(5):S1758-61; discussion S1792-9. doi: 10.1016/s0003-4975(02)04135-8.
Aortic valve-sparing operations are an alternative to aortic root replacement in patients with aortic root aneurysms, or aortic valve replacement and supracoronary replacement of the ascending aorta in patients with ascending aorta aneurysms and dilated sinotubular junctions with consequent aortic insufficiency.
From 1988 to 2001, 230 patients underwent aortic valve-sparing operations for aortic root aneurysms (151 patients) or ascending aortic aneurysms with aortic insufficiency (79 patients). Two types of aortic valve-sparing operations were performed in patients with aortic root aneurysms: reimplantation of the aortic valve and remodeling of the aortic root. Mean follow-up was 3.8 +/- 2.8 years.
Patients with aortic root aneurysms were younger, had less severe aortic insufficiency, less extensive vascular disease, and better left ventricular function than patients with ascending aorta aneurysms. The 8-year survival was 83% +/- 5% for the first group and 36% +/- 14% for the second. The freedom from aortic valve reoperation at 8 years was 99% +/- 1% for the first group and 97% +/- 2% for the second. In patients who had aortic root aneurysms, 3 developed severe aortic insufficiency (AI), and 15 developed moderate AI, for an 8-year freedom from significant AI of 67% +/- 7%. But freedom from AI was 90% +/- 3% after the technique of reimplantation, and 55% +/- 6% after the technique of remodeling (p = 0.02). In patients with ascending aortic aneurysms, the freedom from AI greater than 2+ at 8 years was 67% +/- 11%.
The long-term results of aortic valve sparing for aortic root aneurysms are excellent, and reimplantation of the aortic valve may provide a more stable repair of the aortic valve than remodeling of the aortic root.
对于主动脉根部瘤患者，保留主动脉瓣手术是主动脉根部置换的一种替代方案；对于升主动脉瘤合并窦管交界扩张及主动脉瓣关闭不全的患者，保留主动脉瓣手术是主动脉瓣置换及升主动脉超冠状动脉置换的一种替代方案。
1988年至2001年，230例患者因主动脉根部瘤（151例）或合并主动脉瓣关闭不全的升主动脉瘤（79例）接受了保留主动脉瓣手术。对于主动脉根部瘤患者，实施了两种保留主动脉瓣手术：主动脉瓣再植入术和主动脉根部重塑术。平均随访时间为3.8±2.8年。
与升主动脉瘤患者相比，主动脉根部瘤患者更年轻，主动脉瓣关闭不全程度较轻，血管疾病范围较小，左心室功能较好。第一组8年生存率为83%±5%，第二组为36%±14%。第一组8年无主动脉瓣再次手术率为99%±1%，第二组为97%±2%。在主动脉根部瘤患者中，3例出现严重主动脉瓣关闭不全（AI），15例出现中度AI，8年无明显AI发生率为67%±7%。但再植入术式术后无AI发生率为90%±3%，重塑术式术后为55%±6%（p=0.02）。在升主动脉瘤患者中，8年无AI大于2+的发生率为67%±11%。
保留主动脉瓣治疗主动脉根部瘤的长期效果良好，与主动脉根部重塑术相比，主动脉瓣再植入术可能为主动脉瓣提供更稳定的修复。
