Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany.
Eur J Cardiothorac Surg. 2011 Nov;40(5):1052-7. doi: 10.1016/j.ejcts.2011.02.018. Epub 2011 Mar 23.
Although the aortic-valve-sparing (AVS) reimplantation technique according to David has shown favorable durability results in mid-term and long-term studies, composite valve grafting (CVG) according to Bentall is still considered the standard procedure.
Retrospectively, we evaluated the results of aortic root replacement of patients with Marfan syndrome (MFS) who underwent surgery between January 1995 and January 2010. MFS was diagnosed using the Ghent criteria. AVS was used in 58 patients and CVG in 30 patients with MFS. AVS was done for aortic-root aneurysm (n=48) or aortic dissection type A (n=10). CVG was used for aortic-root aneurysm in 14 patients or aortic dissection type A in 16 patients. The mean follow-up was 3.2 (95% CI: 2.4-4.2) years.
In both groups, 30-day mortality was 0%. Three patients (10.0%) in the CVG group required resternotomy for postoperative bleeding versus two patients (3.4%) in the AVS group (p=0.3). At follow-up, mortality was 10% in the CVG group versus 3.4% in the AVS group (p=0.3). Re-operation was required in two patients (3.4%) after AVS and in three patients after CVG (10%) (p=0.3). Three patients (10.0%) who underwent CVG had endocarditis and two patients (6.7%) had a stroke during follow-up, whereas no endocarditis and stroke occurred after AVS. After 14 years, stratified event-free survival was better in the AVS group (event-free survival was 82.3% vs 58.6%, log-rank test p=0.086), especially after aneurysm (p=0.057). After 10 years, freedom from aortic regurgitation ≥II° in the AVS group was 80% for aneurysm and 50% after dissection (p=0.524).
The reimplantation technique according to David was associated with excellent survival, good valve function and a low rate of re-operation, endocarditis, and stroke. There was a trend to better event-free survival for AVS patients making it the procedure of choice in MFS patients.
尽管 David 主动脉瓣保留（AVS）再植入技术在中期和长期研究中显示出良好的耐久性结果，但根据 Bentall 的复合瓣移植（CVG）仍然被认为是标准手术。
回顾性评估 1995 年 1 月至 2010 年 1 月间接受手术的马凡综合征（MFS）患者行主动脉根部置换术的结果。MFS 采用根特标准进行诊断。58 例患者采用 AVS，30 例患者采用 CVG。AVS 用于主动脉根部瘤（n=48）或主动脉夹层 A 型（n=10）。14 例患者采用 CVG 治疗主动脉根部瘤，16 例患者采用 CVG 治疗主动脉夹层 A 型。平均随访 3.2 年（95%CI：2.4-4.2）。
两组患者术后 30 天死亡率均为 0%。CVG 组 3 例（10.0%）因术后出血需再次开胸，而 AVS 组 2 例（3.4%）（p=0.3）。随访时，CVG 组死亡率为 10.0%，AVS 组为 3.4%（p=0.3）。AVS 后有 2 例（3.4%）患者和 CVG 后有 3 例（10%）患者需要再次手术（p=0.3）。CVG 组有 3 例（10.0%）患者发生心内膜炎，2 例（6.7%）患者在随访期间发生中风，而 AVS 后无心内膜炎和中风发生。14 年后，AVS 组的无事件生存率更好（无事件生存率为 82.3%比 58.6%，分层 log-rank 检验 p=0.086），尤其是在动脉瘤患者中（p=0.057）。10 年后，AVS 组的主动脉瓣反流<II 级的无复发率在动脉瘤患者中为 80%，在夹层患者中为 50%（p=0.524）。
David 再植入技术具有良好的生存率、良好的瓣膜功能和较低的再次手术、心内膜炎和中风发生率。AVS 患者的无事件生存率有改善趋势，使其成为 MFS 患者的首选手术。
