Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Eur J Cardiothorac Surg. 2012 Jan;41(1):56-61; discussion 61-2. doi: 10.1016/j.ejcts.2011.04.012.
Aortic valve-sparing David procedure has gained broad acceptance. However, few long-term results have been published. We present our results.
More than 450 David procedures have been performed in our institution so far. Of these, 126 patients were operated between July 1993 and December 2000. Median age was 57 (8-83) years and 46 (36.5%) were female. As many as 26 (20.6%) had Marfan syndrome, 21 (16.7%) had acute aortic dissection type A (AADA) and 67 (53.2%) had additional procedures.
There were six (4.8%) deaths in 30 post-operative period (POD), four of whom had AADA. In the follow-up, there were 32 (25.4%) late deaths, 11 (34.4%) of these were caused by cardiac or underlying disease or op-related. As many as 15 (11.9%) patients were re-operated; six (40%) were Marfan patients and two (13.3%) had early endocarditis. Follow-up echocardiography of 76 (60.3%) event-free patients showed valve insufficiency (AI)≤AI I° in 68 (89.5%) and grade II in 7 (9.2%) patients. Leaflet degeneration due to proposed leaflet contact with the straight Dacron graft was not observed. A total of 36 (47.4%) patients were in New York Heart Association (NYHA) class I, 33 (43.4%) in NYHA II, and five (6.6%) were in class III. During the entire follow-up of 790 patient-years, there was no stroke or major bleeding. Survival at 1, 5 and 10 years was 93%, 85% and 70%, respectively. Freedom from valve replacement at 1, 5 and 10 years was 96%, 91% and 87%, respectively.
Regardless of the underlying pathology, valve-sparing David I procedure has acceptable long-term results. Valve-related complications such as stroke or major bleeding is exceedingly low.
保留主动脉瓣的 David 手术已经得到广泛认可。然而，目前仅有少数长期结果公布。我们报告我们的结果。
到目前为止，我院已进行了超过 450 例 David 手术。其中，1993 年 7 月至 2000 年 12 月期间手术的患者有 126 例。中位年龄为 57（8-83）岁，46 例（36.5%）为女性。26 例（20.6%）患有马凡综合征，21 例（16.7%）患有急性 A 型主动脉夹层（AADA），67 例（53.2%）接受了其他手术。
术后 30 天内有 6 例（4.8%）死亡，其中 4 例患有 AADA。在随访中，有 32 例（25.4%）晚期死亡，其中 11 例（34.4%）由心脏或基础疾病或 op 相关引起。15 例（11.9%）患者再次手术，其中 6 例（40%）为马凡患者，2 例（13.3%）患有早期心内膜炎。对 76 例（60.3%）无事件患者的超声心动图随访显示，瓣膜功能不全（AI）≤AI I°的有 68 例（89.5%），AI II°的有 7 例（9.2%）。未观察到因建议的瓣叶与直型 Dacron 移植物接触而导致瓣叶退化。共有 36 例（47.4%）患者为纽约心脏病协会（NYHA）心功能Ⅰ级，33 例（43.4%）为 NYHA Ⅱ级，5 例（6.6%）为 NYHA Ⅲ级。在整个 790 患者年的随访中，无卒中或大出血发生。术后 1、5、10 年生存率分别为 93%、85%和 70%。术后 1、5、10 年无瓣膜置换生存率分别为 96%、91%和 87%。
无论基础病理如何，保留主动脉瓣的 David I 手术都具有可接受的长期结果。瓣膜相关并发症，如卒中或大出血，发生率极低。
