Cardiovascular Clinic, Bad Neustadt, Germany.
J Thorac Cardiovasc Surg. 2012 Feb;143(2):294-302. doi: 10.1016/j.jtcvs.2011.10.056. Epub 2011 Nov 20.
The study was conducted to evaluate the intermediate results after patient-tailored aortic root repair with replacement of isolated sinuses adjusted to the existing aortic annulus diameter rather than annulus downsizing.
Between 2000 and 2009, 236 patients with aortic root disease underwent patient-tailored restoration of the aortic root according to its anatomopathologic condition with repair of 1, 2, or all 3 sinuses in 73, 94, and 69 patients, respectively. Concomitant cusp repair was performed in 106 patients. Insufficiency grades of 0/1+, 2+, 3+, and 4+ were presented in 59, 74, 74, and 29 patients, respectively. All data were collected prospectively and intention-to-treat analysis was performed.
Valve repair was successful in all but 6 patients. At the most recent clinical and echocardiographic follow-up of the remaining patients, which averaged 43 ± 24 months (range, 0.3-115 months), 216 patients showed no or slight aortic regurgitation (grade 0/1+) and 10 patients showed grade 2+. Another 4 patients had grade 3+ regurgitation and underwent aortic valve replacement. The actuarial freedom from aortic regurgitation grade 3+ or more at 8 years was 95.2%. Multivariate logistic regression analysis identified cusp repair as the independent risk factor for an aortic regurgitation grade of 2+ or more with an odds ratio of 10.9 (95% confidence interval, 2.5-47.7; P = .002). The association between aortic annulus size and functional results after repair could not be demonstrated.
Aortic root repair with replacement of isolated sinuses adjusted to the existing aortic annulus leads to excellent, durable results and can be recommended. Cusp disease is a leading aspect affecting functional results of repair. Therefore, establishment of reproducible cusp repair techniques is of utmost importance for further development of reconstructive aortic valve surgery.
本研究旨在评估患者定制的主动脉根部修复术的中期结果，该手术采用与现有主动脉瓣环直径相匹配的孤立窦替换，而非瓣环缩小术。
2000 年至 2009 年间，236 例主动脉根部疾病患者根据其解剖病理情况进行患者定制的主动脉根部修复，分别有 73、94 和 69 例患者修复了 1、2 或全部 3 个窦。106 例患者同时行瓣叶修复。59、74、74 和 29 例患者的瓣叶功能不全程度分别为 0/1+、2+、3+和 4+。所有数据均前瞻性收集并进行意向治疗分析。
除 6 例患者外，其余患者的瓣膜修复均成功。在其余患者的最近一次临床和超声心动图随访中，平均随访时间为 43±24 个月（范围 0.3-115 个月），216 例患者无或轻度主动脉瓣反流（0/1+级），10 例患者为 2+级。另有 4 例患者为 3+级反流，行主动脉瓣置换术。8 年时无或无 3+级以上主动脉瓣反流的累积生存率为 95.2%。多因素逻辑回归分析显示，瓣叶修复是导致 2+级或更高级别主动脉瓣反流的独立危险因素，优势比为 10.9（95%置信区间，2.5-47.7；P=0.002）。瓣环大小与修复后功能结果之间的关系不能被证明。
采用与现有主动脉瓣环直径相匹配的孤立窦替换的主动脉根部修复术可获得优异、持久的效果，值得推荐。瓣叶病变是影响修复功能结果的主要因素。因此，建立可重复的瓣叶修复技术对于进一步发展重建性主动脉瓣手术至关重要。
