de Kerchove Laurent, Boodhwani Munir, Glineur David, Poncelet Alain, Rubay Jean, Watremez Christine, Vanoverschelde Jean-Louis, Noirhomme Philippe, El Khoury Gébrine
Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
Ann Thorac Surg. 2009 Aug;88(2):455-61; discussion 461. doi: 10.1016/j.athoracsur.2009.04.064.
Cusp prolapse management is important in aortic valve (AV) sparing and repair to achieve durable results. We analyzed the midterm outcomes of two different techniques for trileaflet AV prolapse repair.
Between 1996 and 2008, 376 patients underwent elective AV repair: 88 with trileaflet AV (23%) had cusp prolapse repair, plication technique was performed in 34 (39%), resuspension technique in 33 (37%) and plication plus resuspension in 21 (24%). One cusp was repaired in 55 (62%), 2 cusps in 18 (21%), and 3 cusps in 15 (17%).
No hospital deaths occurred. Patients undergoing resuspension with or without plication had more preoperative aortic insufficiency (AI; p = 0.01) and multiple cusp prolapses (p = 0.01). During follow-up (median, 41 months), 4 deaths occurred and 2 were cardiac related. Overall survival at 5 years was 95% +/- 5%. Two patients needed AV reoperation because of recurrent AI or AI plus AV stenosis. Recurrent AI grade > or =3+ developed in 4 patients; 1 with moderate AV stenosis. Freedom from reoperation at 5 years was 100% for plication, 96% +/- 4% for resuspension, and 93% +/- 7% for plication plus resuspension (p = 0.6); respective freedom from AI > or =3+ at 3 years was 100%, 92% +/- 8%, and 89% +/- 11% (p = 0.8).
Cusp plication or resuspension are efficient and durable techniques to correct cusp prolapse in the trileaflet AV. Plication is typically the first choice because of its ease of use and lower risk of overcorrection; however, free margin resuspension is useful in specific situations.
在保留主动脉瓣（AV）和修复主动脉瓣以获得持久效果的过程中，瓣叶脱垂的处理至关重要。我们分析了两种不同技术修复三叶主动脉瓣脱垂的中期结果。
1996年至2008年间，376例患者接受了择期主动脉瓣修复：88例三叶主动脉瓣患者（23%）进行了瓣叶脱垂修复，其中34例（39%）采用折叠技术，33例（37%）采用重新悬吊技术，21例（24%）采用折叠加重新悬吊技术。修复一个瓣叶的有55例（62%），两个瓣叶的有18例（21%），三个瓣叶的有15例（17%）。
无住院死亡病例。采用重新悬吊术（无论是否加用折叠术）的患者术前主动脉瓣关闭不全（AI）更严重（p = 0.01）且多瓣叶脱垂更多见（p = 0.01）。在随访期间（中位时间为41个月），发生4例死亡，其中2例与心脏相关。5年总生存率为95%±5%。2例患者因复发性AI或AI合并主动脉瓣狭窄需要再次进行主动脉瓣手术。4例患者出现复发性AI≥3+级；1例伴有中度主动脉瓣狭窄。折叠术5年再次手术率为100%，重新悬吊术为96%±4%，折叠加重新悬吊术为93%±7%（p = 0.6）；3年时各自AI≥3+的无发生率分别为100%、92%±8%和89%±11%（p = 0.8）。
瓣叶折叠术或重新悬吊术是纠正三叶主动脉瓣瓣叶脱垂的有效且持久的技术。由于操作简便且过度矫正风险较低，折叠术通常是首选；然而，游离缘重新悬吊术在特定情况下有用。
