Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA.
Ann Thorac Surg. 2012 Aug;94(2):587-90; discussion 590-1. doi: 10.1016/j.athoracsur.2011.12.097. Epub 2012 Jun 28.
We reviewed our experience with valve-sparing aortic root reconstruction (VSARR) using the sinus of Valsalva graft in children, teenagers, and young adults with connective tissue disorders.
Results of a single-center experience with VSARR in children, teenagers, and young adults were retrospectively analyzed. End points were death, freedom from reintervention, and freedom from valve dysfunction.
Between 2003 and 2010, 16 patients (Marfan, 9; Loeys Dietz syndrome, 6; conotruncal, 1) underwent VSARR. The mean age was 20±7.4 (range, 9 to 36 years). Indications for VSAAR were aortic root enlargement in 14 (sinus of Valsalva Z-score, 6.2±2) and aortic dissection in 2. Additional procedures included replacement of the ascending aorta in 7, with additional replacement of the aortic arch in 2. No early or late deaths occurred. One patient required a pacemaker. One patient with Loeys-Dietz syndrome required reoperation for aneurysmal dilatation of the coronary buttons. Two patients underwent replacement of the thoracoabdominal aorta for chronic dissection. Follow-up by echocardiography or magnetic resonance imaging at a mean of 33±29 months showed more than mild aortic regurgitation in 2 patients. Both patients with moderate aortic insufficiency also had a bicuspid aortic valve.
VSARR using the sinus of Valsalva graft is a reproducible technique that achieves acceptable early and intermediate results. It is suitable for children, teenagers, and young adults. Anticoagulation is avoided. The procedure is appropriate for emergency operations but should be used with caution in patients with a bicuspid aortic valve.
我们回顾了使用窦部移植物进行保留瓣膜的主动脉根部重建术（VSARR）的经验，该手术适用于患有结缔组织疾病的儿童、青少年和年轻成人。
我们回顾性分析了单中心在儿童、青少年和年轻成人中使用 VSARR 的经验。终点是死亡、无再干预和无瓣膜功能障碍。
2003 年至 2010 年，16 例患者（马凡氏综合征 9 例，Loeys-Dietz 综合征 6 例，圆锥动脉干畸形 1 例）接受了 VSARR。平均年龄为 20±7.4 岁（范围为 9 至 36 岁）。VSARR 的适应证为主动脉根部扩大 14 例（窦部 Z 值为 6.2±2）和主动脉夹层 2 例。其他手术包括 7 例升主动脉置换术，其中 2 例合并主动脉弓置换术。无早期或晚期死亡。1 例患者需要起搏器。1 例 Loeys-Dietz 综合征患者因冠状动脉瓣瘤样扩张需要再次手术。2 例患者因慢性夹层而行胸腹主动脉置换术。平均随访 33±29 个月，通过超声心动图或磁共振成像发现 2 例患者存在重度以上主动脉瓣反流。2 例中度主动脉瓣关闭不全的患者均有二叶主动脉瓣。
使用窦部移植物的 VSARR 是一种可重复的技术，可获得可接受的早期和中期结果。它适用于儿童、青少年和年轻成人。避免了抗凝。该手术适用于急诊手术，但在二叶主动脉瓣患者中应谨慎使用。
