Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany.
J Thorac Cardiovasc Surg. 2013 Mar;145(3):774-80. doi: 10.1016/j.jtcvs.2012.03.016. Epub 2012 Apr 11.
Recurrent aortic regurgitation can occur after valve-preserving aortic replacement. Little is known about the exact mechanisms of valve failure and the best reoperative strategies. We analyzed our experience with reoperation after aortic valve reimplantation.
From November 1995 to August 2011, 13 patients (10 men; age, 18-58 years) underwent reoperation for valve failure after aortic valve reimplantation. The reason for reoperation was aortic regurgitation in 11 and endocarditis in 2 after 6 weeks to 13 years. The morphologic causes of regurgitation were cusp prolapse in 6, cusp retraction in 4, cusp perforation in 6, inadequate commissural height in 5, commissural dehiscence in 2, and inadequate valve configuration in 1, alone or combined. The patients were treated by valve replacement (n = 4) or cusp repair (n = 2). In 3 patients, composite replacement of the valve and root was necessary, in 1 with a pulmonary autograft. In 4 patients the aortic valve was spared. All patients were followed up regularly.
No patient died early; 1 patient died 4 years after reoperation. One patient required reoperation 2 years after the cusp repair procedure. All patients with repeat valve-preserving root replacement had stable valve function postoperatively. The 5-year survival rate after reoperation was 86% ± 13%. The 5-year rate of freedom from valve-related complications was 78% ± 14%.
Recurrent aortic regurgitation early after aortic valve reimplantation frequently involves cusp prolapse and a low commissural height; later, cusp retraction becomes more important. Reoperation within the first 6 postoperative months allows for preservation of the native aortic valve; however, beyond this period, valve replacement within the graft will mostly be required.
保留主动脉瓣置换术后可能会发生复发性主动脉瓣关闭不全。对于瓣膜失败的确切机制和最佳再次手术策略知之甚少。我们分析了我们在主动脉瓣再植入后的再次手术经验。
1995 年 11 月至 2011 年 8 月，13 例患者（10 例男性；年龄 18-58 岁）因主动脉瓣再植入后瓣膜功能障碍而接受再次手术。再手术的原因是 11 例主动脉瓣关闭不全，2 例为感染性心内膜炎，术后时间为 6 周至 13 年。反流的形态学原因是 6 例瓣叶脱垂，4 例瓣叶回缩，6 例瓣叶穿孔，5 例瓣叶交界高度不足，2 例瓣叶交界分离，1 例瓣叶成形不良，单独或联合。患者接受瓣膜置换术（n=4）或瓣叶修复术（n=2）。在 3 例患者中，需要进行瓣膜和根部的复合置换，其中 1 例使用肺动脉自体移植物。在 4 例患者中，保留了主动脉瓣。所有患者均定期随访。
无患者早期死亡；1 例患者在再次手术后 4 年死亡。1 例接受瓣叶修复术后 2 年再次手术。所有接受再次保留瓣膜根部置换术的患者术后瓣膜功能稳定。再次手术后 5 年生存率为 86%±13%。5 年无瓣膜相关并发症的生存率为 78%±14%。
主动脉瓣再植入术后早期复发性主动脉瓣关闭不全常涉及瓣叶脱垂和交界高度较低；后期瓣叶回缩更为重要。术后 6 个月内再次手术可保留自体主动脉瓣；然而，超过这个时间，在移植物内进行瓣膜置换将是主要的选择。
