Jeanmart Hugues, de Kerchove Laurent, Glineur David, Goffinet Jean-Michel, Rougui Ishan, Van Dyck Michel, Noirhomme Philippe, El Khoury Gebrin
Department of Cardiovascular and Thoracic Surgery, UCL-Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Ann Thorac Surg. 2007 Feb;83(2):S746-51; discussion S785-90. doi: 10.1016/j.athoracsur.2006.10.089.
Combined aortic valve repair and aortic valve-sparing surgery requires an approach determined by the leaflets and aortic root anatomy.
Among patients referred for aortic root aneurysm, 114 patients underwent an aortic valve-sparing procedure in which a reimplantation or remodelling technique was used. The Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, UK) was used in 45 patients. Better molding of the prosthesis on the aortic annulus was achieved by a low proximal dissection and incisions on the prosthesis to respect the anatomy of the aortoventricular junction. The reimplantation technique was used in 58%, and 62% of all patients underwent an associated leaflet procedure.
The operative mortality rate was 1%, with a 2% immediate reoperation rate. During the mean follow-up 50 +/- 35 months, 3 patients (2.6%) needed reoperation for recurrent aortic regurgitation (n = 2) or aortic stenosis (n = 1). At the end of follow-up, aortic regurgitation grade exceeding 2 had occurred in 2.6% of patients (n = 3), and 98.2% were in New York Heart Association functional class 1 or 2. Neither the early nor mid-term results showed any differences among the different surgical techniques used (reimplantation, remodeling, Valsalva prosthesis, additional leaflet repair).
A complete approach to the different components of the aortic root allows good clinical results at mid-term.
主动脉瓣修复与保留主动脉瓣手术相结合需要根据瓣叶和主动脉根部解剖结构来确定手术方法。
在因主动脉根部瘤前来就诊的患者中，114例患者接受了保留主动脉瓣手术，采用了再植入或重塑技术。45例患者使用了Gelweave Valsalva人工瓣膜（英国伦弗鲁郡苏尔寿血管泰克公司）。通过低位近端解剖和在人工瓣膜上做切口以尊重主动脉心室连接部的解剖结构，使人工瓣膜在主动脉瓣环上的塑形更好。58%的患者采用了再植入技术，所有患者中有62%接受了相关的瓣叶手术。
手术死亡率为1%，即刻再次手术率为2%。在平均50±35个月的随访期间，3例患者（2.6%）因复发性主动脉瓣反流（n = 2）或主动脉瓣狭窄（n = 1）需要再次手术。随访结束时，2.6%的患者（n = 3）出现主动脉瓣反流分级超过2级的情况，98.2%的患者纽约心脏协会心功能分级为1级或2级。无论是早期还是中期结果，在使用的不同手术技术（再植入、重塑、Valsalva人工瓣膜、额外的瓣叶修复）之间均未显示出任何差异。
对主动脉根部不同组成部分采取完整的手术方法可在中期取得良好的临床效果。
