Kawachi Y, Tominaga R, Tokunaga K
Division of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1259-63.
Although Manouguian's operation is well established, there have been little long-term data published on its outcome. From January 1980 to June 1988, 15 patients underwent patch enlargement of the small aortic anulus by Manouguian's approach, either with aortic single valve replacement (7 patients) or with aortic-mitral double valve replacement (8 patients). Follow-up ranged from 3.0 to 11.4 years (mean 8.5) and was completed with a cumulative total of 102 patient-years. One patient died of fulminant hemolysis, probably related to turbulent jet flow and Dacron patch material (operative mortality 6.7%). There were four late deaths, and the actuarial survival, including operative death at 10 years, was 62% +/- 14%. Reoperations were performed seven times in six patients. Most of these complications were not considered to be caused by the anulus-enlarging procedure. Actuarial freedom rate from reoperation at 10 years was 65% +/- 15%. Four patients underwent rereplacement of prostheses for Hancock valve failure during 2.9 to 11.3 years (mean 8.2 years). The anulus enlargement was found to be well healed and presented no problem during reoperation. Surgically induced mitral regurgitation by Manouguian's procedure was observed in two patients. The regurgitation did not progress during follow-up duration of 1.9 to 10.0 years, nor did it cause congestive heart failure. Annular enlargement by Manouguian's procedure with use of mechanical valves is one of the good selections in patients with the narrow aortic valve ring.
尽管马努吉安手术已被广泛应用，但关于其长期疗效的公开数据却很少。1980年1月至1988年6月，15例患者采用马努吉安方法进行了小主动脉瓣环补片扩大术，其中7例行主动脉单瓣膜置换术，8例行主动脉 - 二尖瓣双瓣膜置换术。随访时间为3.0至11.4年（平均8.5年），累计随访102患者年。1例患者死于暴发性溶血，可能与湍流喷射流和涤纶补片材料有关（手术死亡率6.7%）。有4例晚期死亡，10年时包括手术死亡在内的精算生存率为62%±14%。6例患者进行了7次再次手术。这些并发症大多不被认为是由瓣环扩大手术引起的。10年时再次手术的精算无再手术率为65%±15%。4例患者在2.9至11.3年（平均8.2年）期间因汉考克瓣膜功能衰竭进行了人工瓣膜再次置换。发现瓣环扩大愈合良好，再次手术时未出现问题。在2例患者中观察到马努吉安手术导致的外科性二尖瓣反流。在1.9至10.0年的随访期间，反流未进展，也未导致充血性心力衰竭。对于主动脉瓣环狭窄的患者，采用马努吉安手术并使用机械瓣膜进行瓣环扩大是较好的选择之一。
