Kallenbach Klaus, Baraki Hassina, Khaladj Nawid, Kamiya Hiroyuki, Hagl Christian, Haverich Axel, Karck Matthias
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
Ann Thorac Surg. 2007 Feb;83(2):S764-8; discussion S785-90. doi: 10.1016/j.athoracsur.2006.10.097.
We assessed the outcome in patients with Marfan syndrome operated on exclusively with the aortic valve-sparing reimplantation technique for aortic root aneurysms during more than a decade.
Between July 1993 and April 2005, the aortic valve-sparing reimplantation technique (David I) was used in 325 patients. In 59 patients with clinical evidence of Marfan syndrome, procedures were done for aortic root aneurysm (n = 55) or aortic dissection type A (n = 4). Their mean age was 30 +/- 12 years (range, 9 to 62 years), and 37 (63%) were male. Additional procedures were arch replacement in 4 patients, coronary artery bypass grafting in 1, mitral valve surgery in 9, and closure of atrial septal defect in 3. Mean follow-up was 54 +/- 37 months (range, 0 to 139 months).
No patient died during the first 30 days postoperatively. Mean bypass time was 163 +/- 34 minutes (range, 99 to 248 minutes), and mean aortic cross clamp time was 126 +/- 28 minutes (range, 78 to 202 minutes). Four patients (6.8%) required rethoracotomy for postoperative bleeding. Five late deaths (8.5%) occurred during follow-up. Reoperation of the reconstructed valve was required in 7 patients. Freedom from reoperation was 88% +/- 5% at 5 years and 80% +/- 9% at 10 years. Mean grade of aortic insufficiency was 1.81 preoperatively compared with 0.20 early postoperatively (p < 0.001). At last investigation, the mean grade of aortic insufficiency increased slightly to 0.22 (p = 0.16). Anticoagulation was not required in 67% of patients. One thromboembolic complication and four instances of minor bleeding were documented. All patients were in New York Heart Association functional class I (86%) or II at last contact.
Excellent early outcome, favorable long-term results, and acceptable durability of the reimplanted valve should encourage use of this technique in patients with Marfan syndrome.
我们评估了在超过十年间仅采用保留主动脉瓣再植入技术治疗主动脉根部瘤的马方综合征患者的预后情况。
1993年7月至2005年4月期间，325例患者采用了保留主动脉瓣再植入技术（David I）。在59例有马方综合征临床证据的患者中，因主动脉根部瘤（n = 55）或A型主动脉夹层（n = 4）进行了手术。他们的平均年龄为30±12岁（范围9至62岁），男性37例（63%）。另外4例患者进行了主动脉弓置换，1例进行了冠状动脉旁路移植术，9例进行了二尖瓣手术，3例进行了房间隔缺损修补术。平均随访时间为54±37个月（范围0至139个月）。
术后30天内无患者死亡。平均体外循环时间为163±34分钟（范围99至248分钟），平均主动脉阻断时间为126±28分钟（范围78至202分钟）。4例患者（6.8%）因术后出血需要再次开胸。随访期间发生5例晚期死亡（8.5%）。7例患者需要对重建瓣膜进行再次手术。5年时无需再次手术的比例为88%±5%，10年时为80%±9%。术前主动脉瓣反流平均分级为1.81，术后早期为0.20（p < 0.001）。在最后一次检查时，主动脉瓣反流平均分级略有增加至0.22（p = 0.16）。67%的患者无需抗凝治疗。记录到1例血栓栓塞并发症和４例轻微出血事件。最后一次随访时，所有患者的纽约心脏协会心功能分级均为I级（86%）或II级。
良好的早期预后、有利的长期结果以及再植入瓣膜可接受的耐久性应促使在马方综合征患者中使用该技术。
