Carr John Alfred, Savage Edward B
Department of Cardiovascular-Thoracic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Rush Medical College, 1653 West Congress Parkway, Chicago, IL 60612, USA.
Eur J Cardiothorac Surg. 2004 Jan;25(1):6-15. doi: 10.1016/j.ejcts.2003.09.018.
In evaluating the goal of aortic valve preservation, there have been 11 reports of large series of aortic valve repair for aortic insufficiency in adults published in recent years. We sought to analyze the validity of these methods and compare them to published results for bioprosthetic valves, pulmonary autografts, and aortic homografts. From 1990 to 2002, 761 adult aortic valve repairs were reported. Perioperative morbidity ranged from 3.6 to 23% (mean 14%), early mortality 0-8% (mean 3.6%), and late mortality 0-8% (mean 2.8%). The 5- and 10-year freedom from reoperation rates for repair were 89 and 64%. Although early results are good, long-term analysis suggests that, as a group, the durability of repair is unclear. Patients with rheumatic valvular disease appear to have an increased incidence of recurrence and repair failure. Although suture line dehiscence continues to be both an early and late complication with repair, the long-term morbidity and mortality is low and valve repair may be an option in carefully selected patients. However, the inability to break down the results by techniques does not allow for a definitive conclusion. Further subanalysis is necessary as larger series are reported. Proponents must attempt to separate successful from unsuccessful techniques. Aortic valve repair is a technique in evolution.
在评估保留主动脉瓣这一目标时，近年来已有11篇关于成人大主动脉瓣关闭不全进行主动脉瓣修复的大宗病例报告发表。我们试图分析这些方法的有效性，并将其与已发表的生物瓣膜、自体肺动脉瓣和主动脉同种异体移植物的结果进行比较。1990年至2002年期间，共报告了761例成人主动脉瓣修复手术。围手术期发病率在3.6%至23%之间（平均14%），早期死亡率为0%至8%（平均3.6%），晚期死亡率为0%至8%（平均2.8%）。修复术后5年和10年免于再次手术的比例分别为89%和64%。尽管早期结果良好，但长期分析表明，总体而言，修复的耐久性尚不清楚。风湿性瓣膜病患者的复发和修复失败发生率似乎有所增加。虽然缝线裂开仍然是修复手术的早期和晚期并发症，但长期发病率和死亡率较低，对于经过精心挑选的患者，瓣膜修复可能是一种选择。然而，由于无法按技术对结果进行分类分析，因此无法得出明确结论。随着更多大宗病例报告的发表，有必要进行进一步的亚组分析。支持者必须尝试区分成功和不成功的技术。主动脉瓣修复是一种不断发展的技术。
