Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg, Germany.
J Thorac Cardiovasc Surg. 2012 Jun;143(6):1389-95. doi: 10.1016/j.jtcvs.2011.07.036. Epub 2011 Sep 8.
Technical controversies exist in valve-preserving aortic root replacement. We sought to determine predictors of long-term stability of the aortic valve.
A total of 430 patients (aged 57 ± 15 years, 323 male) underwent valve-preserving aortic root surgery (remodeling in 401, reimplantation in 29) between 1995 and 2009 and were followed echocardiographically. Factors influencing late recurrence of aortic valve regurgitation grade II or greater (n = 45) or need for reoperation on the aortic valve (n = 25) were analyzed.
Early mortality was 2.8% (1.9% for elective cases), and actuarial survival at 10 years was 83.5% ± 2.4%. Ten-year freedom from aortic valve regurgitation grade II or greater was 85.0% ± 2.5%. Preoperative aortoventricular junction diameter greater than 28 mm and postoperative effective height of the aortic cusp less than 9 mm were identified as significant predictors for late aortic valve regurgitation grade II or greater in multivariate analysis (both P < .001). Ten-year freedom from reoperation on the aortic valve was 89.3% ± 2.5%. Preoperative aortoventricular junction diameter greater than 28 mm (P < .001), use of pericardial patch (P = .022), and effective height of the aortic cusp less than 9 mm (P = .049) were identified as significant predictors for reoperation in multivariate analysis. Operative technique (remodeling, reimplantation), Marfan syndrome, bicuspid valve anatomy, concomitant central cusp plication, size of prosthesis used, and acute dissection were not associated with an increased risk of late aortic valve regurgitation grade II or greater or reoperation. In patients with preoperative aortoventricular junction diameter greater than 28 mm (n = 94), the addition of central cusp plication significantly improved freedom from aortic valve regurgitation grade II or greater (P = .006) regardless of root procedures (remodeling, P = .011; reimplantation, P = .053).
Long-term stability of valve-preserving aortic root replacement was influenced not by the technique of root repair but by the preoperative aortic root geometry and postoperative cusp configuration.
在保留瓣膜的主动脉根部置换术中存在技术争议。我们旨在确定影响主动脉瓣长期稳定性的预测因素。
1995 年至 2009 年间，共有 430 例患者（年龄 57 ± 15 岁，323 例男性）接受了保留瓣膜的主动脉根部手术（401 例为重塑，29 例为再植入），并进行了超声心动图随访。分析影响主动脉瓣反流程度 II 级或更高级别（n = 45）或主动脉瓣再次手术（n = 25）的晚期复发的因素。
早期死亡率为 2.8%（择期手术为 1.9%），10 年生存率为 83.5% ± 2.4%。10 年无主动脉瓣反流程度 II 级或更高级别的生存率为 85.0% ± 2.5%。多变量分析显示，术前主动脉瓣环直径大于 28mm 和术后主动脉瓣有效高度小于 9mm 是晚期主动脉瓣反流程度 II 级或更高级别的显著预测因素（均 P<0.001）。10 年无主动脉瓣再次手术的生存率为 89.3% ± 2.5%。术前主动脉瓣环直径大于 28mm（P<0.001）、使用心包补片（P=0.022）和主动脉瓣有效高度小于 9mm（P=0.049）是多变量分析中主动脉瓣再次手术的显著预测因素。手术技术（重塑、再植入）、马凡综合征、二叶式主动脉瓣解剖、中央瓣叶成形术、使用的假体大小以及急性夹层均与晚期主动脉瓣反流程度 II 级或更高级别或再次手术无关。在术前主动脉瓣环直径大于 28mm 的患者中（n = 94），无论根部手术方式（重塑，P=0.011；再植入，P=0.053）如何，添加中央瓣叶成形术均显著提高了主动脉瓣反流程度 II 级或更高级别的无复发率（P=0.006）。
保留瓣膜的主动脉根部置换术的长期稳定性不受根部修复技术的影响，而受术前主动脉根部几何形状和术后瓣叶形态的影响。
