Oshima H, Usui A, Akita T, Ueda Y
Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Japan.
Kyobu Geka. 2006 Apr;59(4):269-75.
Aortic valve surgery for the small aortic annulus is still challenging for surgeons. Recently, the new types of high performance prosthesis have been developed and the chance of an aortic root enlargement (ARE) is decreasing. In this study, we propose the ideal strategy of the aortic surgery for the small aortic annulus. We analyzed the clinical records of 158 patients who underwent aortic valve replacement from August 1999 to October 2005 in our institution. The small aortic annulus was observed in 38 patients (24%). Fourteen patients of this group underwent ARE. Patient-prosthesis mismatch (PPM) was less frequently observed in patients with ARE compared to those without ARE. The additional time required for ARE was not considerable, and neither ischemic time nor cardiopulmonary bypass time was significantly prolonged by ARE. In conclusion, we have to select a prosthesis with sufficient orifice area to avoid PPM, otherwise we should choose an option of ARE. For this consideration, we definitely need the chart that demonstrates the relationship between the nominal size of various types of prostheses and the size of a patient's annulus that those prostheses actually fit.
对于外科医生而言，针对小主动脉瓣环进行主动脉瓣手术仍然具有挑战性。近年来，新型高性能人工瓣膜已被研发出来，主动脉根部扩大术（ARE）的应用机会正在减少。在本研究中，我们提出了针对小主动脉瓣环的主动脉手术的理想策略。我们分析了1999年8月至2005年10月在我院接受主动脉瓣置换术的158例患者的临床记录。其中38例患者（24%）观察到小主动脉瓣环。该组中有14例患者接受了ARE。与未接受ARE的患者相比，接受ARE的患者中人工瓣膜-患者不匹配（PPM）的发生率较低。ARE所需的额外时间并不长，且ARE并未显著延长缺血时间或体外循环时间。总之，我们必须选择具有足够开口面积的人工瓣膜以避免PPM，否则应选择ARE。出于这一考虑，我们绝对需要一张图表，展示各种类型人工瓣膜的标称尺寸与这些人工瓣膜实际适配的患者瓣环尺寸之间的关系。
