Patel Nishant D, Arnaoutakis George J, George Timothy J, Allen Jeremiah G, Alejo Diane E, Dietz Harry C, Cameron Duke E, Vricella Luca A
Johns Hopkins Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):415-9, discussion 419. doi: 10.1510/icvts.2010.255596. Epub 2010 Nov 30.
Valve-sparing root replacement (VSRR) is an attractive option for aortic aneurysm in children with low-operative risk, but mid- and late-term results are not yet known. Between 1997 and 2009, 56 children (mean age 11.5 years) underwent VSRR at our institution. Twenty-six (46.4%) had Marfan syndrome and 24 (42.8%) had Loeys-Dietz syndrome. Mean preoperative max sinus diameter was 4.2±0.8 cm (Z-score 7.7±2.9). Five (8.9%) had >2+ aortic insufficiency (AI). Two (3.6%) underwent David I reimplantation with a straight-tube, 12 (21.4%) had a Yacoub remodeling procedure, and 42 (75.0%) had reimplantation using a Valsalva-graft. There were one (1.8%) operative and three (5.4%) late deaths. One patient required reoperation for bleeding and one required late repair of a distal pseudoaneurysm. Mean follow-up was 5.2 years (range 0-12 years). No patients suffered thromboembolic events or had endocarditis. Of the 12 remodeling patients, four (33.3%) developed >2+ AI and required aortic valve repair or replacement. No patient developed >2+ AI after reimplantation. VSRR in children is a safe alternative to aortic root replacement with mechanical or biological prostheses. In this particular group of patients with connective tissue disorders and proclivity toward annular dilation and late AI, reimplantation is superior to remodeling.
保留瓣膜的主动脉根部置换术（VSRR）对于手术风险低的儿童主动脉瘤患者是一个有吸引力的选择，但中期和长期结果尚不清楚。1997年至2009年期间，56名儿童（平均年龄11.5岁）在我们机构接受了VSRR手术。26名（46.4%）患有马凡综合征，24名（42.8%）患有洛伊迪茨综合征。术前最大窦部直径平均为4.2±0.8 cm（Z值7.7±2.9）。5名（8.9%）患者有>2+级主动脉瓣关闭不全（AI）。2名（3.6%）患者接受了带直管的David I再植入术，12名（21.4%）患者接受了亚库布重塑手术，42名（75.0%）患者使用主动脉窦移植物进行了再植入术。有1例（1.8%）手术死亡和3例（5.4%）晚期死亡。一名患者因出血需要再次手术，一名患者需要对远端假性动脉瘤进行后期修复。平均随访时间为5.2年（范围0至12年）。没有患者发生血栓栓塞事件或心内膜炎。在12名接受重塑手术的患者中，4名（33.3%）出现>2+级AI，需要进行主动脉瓣修复或置换。再植入术后没有患者出现>2+级AI。对于儿童，VSRR是使用机械或生物假体进行主动脉根部置换的安全替代方案。在这组患有结缔组织疾病且倾向于瓣环扩张和晚期AI的特定患者中，再植入术优于重塑手术。
