Department of Cardiac Surgery and Marfan Center, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2010 Sep;11(9):648-54. doi: 10.2459/JCM.0b013e3283379998.
The aim of the study is to compare mid-term results of Bentall aortic root replacement with composite mechanical valved conduit and aortic valve reimplantation procedure using the Valsalva graft for the treatment of aortic root aneurysm in patients with Marfan syndrome.
We retrospectively compared data of 23 patients (mean age 38 + or - 14 years) who had undergone the Bentall procedure (group B) to those of 24 patients (mean age 36 + or - 12 years) who had undergone aortic valve reimplantation (group R) during a 14-year period. Follow-up (mean duration 65 + or - 44 months) was 100% complete.
There were no operative deaths in either group. In group B, as compared with group R, preoperative aortic insufficiency (3.2 + or - 1.1/4 vs. 1.7 + or - 1.4/4, P < 0.001), ascending aorta diameter (55.8 + or - 4.9 vs. 44.1 + or - 8.7 mm, P = 0.001) were prevailing; cardiopulmonary bypass (107 + or - 51 vs. 145 + or - 32 min, P < 0.05) and aortic cross-clamp (77 + or - 17 vs. 116 + or - 30 min, P = 0.005) times were shorter. Eight-year survival and freedom from cardiac death and reoperation were 91 + or - 6, 96 + or - 4 and 100% in group B and 100, 100 and 91 + or - 6% in group R, respectively (P = NS for all comparisons). At follow-up, echocardiography showed significant improvement of left ventricular ejection fraction (0.60 + or - 0.10 vs. 0.52 + or - 0.09 preoperatively, P = 0.01) and end-systolic diameter (34 + or - 5 vs. 47 + or - 14 mm, P = 0.001) in group B and significant reduction of preoperative aortic insufficiency (0.7 + or - 1.0/4 vs. 1.7 + or - 1.4/4, P = 0.01) and aortic annulus (24 + or - 2.4 vs. 33 + or - 5 mm, P = 0.01) in group R.
In Marfan patients, the Bentall procedure is associated with excellent mid-term outcome. The reimplantation technique, adopted for less dilated aortas, provides similarly satisfactory results. The Valsalva graft seems, with time, to allow a stable aortic valve function.
本研究旨在比较 Bentall 主动脉根部置换术与复合机械瓣带瓣管道及主动脉瓣再植入术（使用 Valsalva 移植物）治疗马凡综合征患者主动脉根部瘤的中期结果。
我们回顾性比较了 23 例（平均年龄 38+/-14 岁）接受 Bentall 手术（B 组）和 24 例（平均年龄 36+/-12 岁）接受主动脉瓣再植入术（R 组）患者的数据，随访时间（平均 65+/-44 个月）为 100%。
两组均无手术死亡。B 组与 R 组相比，术前主动脉瓣关闭不全（3.2+/-1.1/4 比 1.7+/-1.4/4，P<0.001）、升主动脉直径（55.8+/-4.9 比 44.1+/-8.7mm，P=0.001）较大；体外循环时间（107+/-51 比 145+/-32min，P<0.05）和主动脉阻断时间（77+/-17 比 116+/-30min，P=0.005）较短。B 组 8 年生存率、无心脏死亡和再次手术率分别为 91+/-6%、96+/-4%和 100%，R 组分别为 100%、100%和 91+/-6%（所有比较 P=NS）。随访时，超声心动图显示 B 组左心室射血分数（0.60+/-0.10 比术前 0.52+/-0.09，P=0.01）和收缩末期直径（34+/-5 比 47+/-14mm，P=0.001）显著改善，而 R 组主动脉瓣关闭不全（0.7+/-1.0/4 比 1.7+/-1.4/4，P=0.01）和主动脉瓣环（24+/-2.4 比 33+/-5mm，P=0.01）显著降低。
在马凡综合征患者中，Bentall 手术具有良好的中期结果。对于扩张较小的主动脉，再植入技术提供了相似的满意结果。Valsalva 移植物随着时间的推移似乎可以稳定主动脉瓣功能。
