Department of Cardiac Surgery, European Hospital, Rome, Italy.
J Thorac Cardiovasc Surg. 2010 Dec;140(6 Suppl):S23-7; discussion S45-51. doi: 10.1016/j.jtcvs.2010.07.060.
The Valsalva graft is a specifically designed Dacron graft that, on implantation and pressurization, generates pseudosinuses of Valsalva. We reviewed a multicenter experience of the reimplantation procedure with the Valsalva graft in patients with aneurysms involving the aortic root.
A total of 278 patients underwent valve-sparing aortic root replacement using the Valsalva graft at 4 different Italian cardiac surgery centers and were studied by clinical assessment and echocardiography. Of the 278 patients, 220 were men (79%), with a mean age of 56 ± 15 years. Of the patients, 42 (15%) had Marfan syndrome, 31 (11%) had a bicuspid aortic valve, 13 (5%) had acute aortic dissection, and 136 (49%) had grade 3 or 4+ aortic insufficiency. Concomitant cardiac procedures were performed in 78 patients (28%). Additional aortic leaflet repair was necessary in 25 patients (9%). The mean crossclamp time was 120 ± 27 minutes.
There were 5 (1.8%) operative and 5 (1.8%) late deaths. The mean follow-up was 52 ± 28 months (range, 2-112 months) and was 100% complete. The cumulative actuarial survival was 95.2% (268 patients). A total of 32 patients (11%) had grade 3 to 4+ aortic insufficiency, and 17 of these required late aortic valve replacement (range, 3-78 months). At 10 years of follow-up, the freedom from aortic valve reoperation rate was 91%, and the rate of freedom from residual aortic insufficiency not needing reoperation was 88%.
The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.
Valsalva 移植物是一种专门设计的膨体聚四氟乙烯移植物，在植入和加压后，会产生 Valsalva 假窦。我们回顾了在 4 家意大利心脏外科中心的 278 例涉及主动脉根部的动脉瘤患者中，使用 Valsalva 移植物进行再植入手术的多中心经验。
278 例患者在 4 家意大利心脏外科中心接受了使用 Valsalva 移植物的保留瓣膜主动脉根部置换术，并通过临床评估和超声心动图进行研究。278 例患者中，220 例为男性（79%），平均年龄为 56 ± 15 岁。其中，42 例（15%）为马凡综合征，31 例（11%）为二叶式主动脉瓣，13 例（5%）为急性主动脉夹层，136 例（49%）为 3 级或 4+主动脉瓣关闭不全。78 例（28%）患者同时进行了心脏手术。25 例（9%）需要进行额外的主动脉瓣叶修复。平均体外循环时间为 120 ± 27 分钟。
5 例（1.8%）手术死亡，5 例（1.8%）晚期死亡。平均随访时间为 52 ± 28 个月（2-112 个月），随访率为 100%。累积存活率为 95.2%（268 例）。共有 32 例（11%）患者出现 3 级至 4+主动脉瓣关闭不全，其中 17 例需要晚期主动脉瓣置换（3-78 个月）。10 年随访时，主动脉瓣再手术的无失败率为 91%，无需再次手术的残余主动脉瓣关闭不全的无失败率为 88%。
Valsalva 移植物的使用可促进再植入型保留瓣膜主动脉根部手术的进行，并可获得满意的围手术期和中期结果。但优化根部重建将如何影响随访的第二个十年，还有待确定。
