Langer Frank, Aicher Diana, Kissinger Anke, Wendler Olaf, Lausberg Henning, Fries Roland, Schäfers Hans-Joachim
Department of Thoracic and Cardiovascular Surgery, University Hospitals Homburg, Homburg, Germany.
Circulation. 2004 Sep 14;110(11 Suppl 1):II67-73. doi: 10.1161/01.CIR.0000138383.01283.b8.
Reconstruction of the aortic valve for aortic regurgitation (AR) remains challenging, in part because of not only cusp or root pathology but also a combination of both can be responsible for this valve dysfunction. We have systematically tailored the repair to the individual pathology of cusps and root.
Between October 1995 and August 2003, aortic valve repair was performed in 282 of 493 patients undergoing surgery for AR and concomitant disease. Root dilatation was corrected by subcommissural plication (n=59), supracommissural aortic replacement (n=27), root remodeling (n=175), or valve reimplantation within a graft (n=24). Cusp prolapse was corrected by plication of the free margin (n=157) or triangular resection (n =36), cusp defects were closed with a pericardial patch (n=16). Additional procedures were arch replacement (n=114), coronary artery bypass graft (n=60) or mitral repair (n=24). All patients were followed-up (follow-up 99.6% complete), and cumulative follow-up was 8425 patient-months (mean, 33+/-27 months).Results- Eleven patients died in hospital (3.9%). Nine patients underwent reoperation for recurrent AR (3.3%). Actuarial freedom from AR grade > or =II at 5 years was 81% for isolated valve repair, 84% for isolated root replacement, and 94% for combination of both; actuarial freedom from reoperation at 5 years was 93%, 95%, and 98%, respectively. No thromboembolic events occurred, and there was 1 episode of endocarditis 4.5 years postoperatively.
Aortic valve repair is feasible even for complex mechanisms of AR with a systematic and individually tailored approach. Operative mortality is low and mid-term durability is encouraging. The incidence of valve-related morbidity is low compared with valve replacement.
主动脉瓣反流（AR）的主动脉瓣重建仍然具有挑战性，部分原因不仅在于瓣叶或根部病变，还在于两者的组合都可能导致这种瓣膜功能障碍。我们已根据瓣叶和根部的个体病变系统地调整了修复方法。
1995年10月至2003年8月期间，493例接受AR及合并疾病手术的患者中有282例接受了主动脉瓣修复。通过瓣下折叠术（n = 59）、瓣上主动脉置换术（n = 27）、根部重塑术（n = 175）或移植物内瓣膜再植入术（n = 24）纠正根部扩张。通过游离缘折叠术（n = 157）或三角形切除术（n = 36）纠正瓣叶脱垂，用心包补片封闭瓣叶缺损（n = 16）。附加手术包括主动脉弓置换术（n = 114）、冠状动脉旁路移植术（n = 60）或二尖瓣修复术（n = 24）。所有患者均接受随访（随访完成率99.6%），累积随访时间为8425患者月（平均33±27个月）。
11例患者在医院死亡（3.9%）。9例患者因复发性AR接受再次手术（3.3%）。单纯瓣膜修复术后5年无AR≥II级的实际发生率为81%，单纯根部置换为84%，两者联合为94%；5年再次手术的实际发生率分别为93%、95%和98%。未发生血栓栓塞事件，术后4.5年有1例感染性心内膜炎。
即使对于具有复杂机制的AR，采用系统的个体化定制方法进行主动脉瓣修复也是可行的。手术死亡率低，中期耐久性令人鼓舞。与瓣膜置换相比，瓣膜相关并发症的发生率较低。
