Hamasaki A, Yaginuma G
Department of Cardiovascular Surgery, Heart Center, Sendai Kosei Hospital, Japan.
Kyobu Geka. 2006 Apr;59(4):289-93.
We routinely perform supra-annular patch enlargement as a strategy to avoid patient-prosthesis mismatch (PPM) in patients with a small aortic annulus who are undergoing aortic valve replacement (AVR).
We performed a retrospective review of 128 consecutive single AVR patients from 1999 to 2005. Of these, 34 patients underwent supra-annular patch enlargement. The enlargement was selectively performed in patients at risk of PPM. This involved patch extension of the aortotomy just above the annulus of noncoronary sinus, and valve implantation with stitches placed directly on the patch. Along with this procedure, AVR with a valve size appropriate to body surface area (BSA) was performed.
Of these patients, 74% were female and the mean BSA was less than 1.50 m2. The enlargement required an average of 33 minutes of additional aortic clamp time. The 30-day mortality was 0%. A favorable hemodynamic outcome was achieved.
Our results show that supra-annular patch enlargement can be performed with minimal added risk, relative to standard root enlargement and a satisfactory hemodynamic status can be achieved by employing this procedure.
对于接受主动脉瓣置换术（AVR）的小主动脉瓣环患者，我们常规进行瓣环上补片扩大术，作为避免患者-人工瓣膜不匹配（PPM）的一种策略。
我们对1999年至2005年连续128例单纯AVR患者进行了回顾性研究。其中，34例患者接受了瓣环上补片扩大术。该扩大术选择性地用于有PPM风险的患者。这包括在无冠窦瓣环上方的主动脉切口处进行补片延伸，并将缝线直接置于补片上进行瓣膜植入。同时，进行与体表面积（BSA）相适应的瓣膜大小的AVR。
这些患者中，74%为女性，平均BSA小于1.50平方米。扩大术平均需要额外33分钟的主动脉阻断时间。30天死亡率为0%。取得了良好的血流动力学结果。
我们的结果表明，相对于标准的根部扩大术，瓣环上补片扩大术可在增加最小风险的情况下进行，并且采用该手术可实现令人满意的血流动力学状态。
