David Tirone E
Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Canada.
Korean J Thorac Cardiovasc Surg. 2012 Aug;45(4):205-12. doi: 10.5090/kjtcs.2012.45.4.205. Epub 2012 Aug 3.
Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.
保留主动脉瓣手术旨在在主动脉根部瘤手术以及伴有主动脉瓣关闭不全的升主动脉瘤手术中保留自身主动脉瓣。保留主动脉瓣手术基本上有两种类型：主动脉根部重塑和主动脉瓣再植入。这些手术已经开展了二十多年，在经验丰富的医生手中临床效果极佳。虽然从生理角度讲，主动脉根部重塑优于主动脉瓣再植入，但长期随访表明，后者发生主动脉瓣关闭不全的风险较低。主动脉根部重塑失败通常是由于主动脉瓣环扩张。因此，这种保留主动脉瓣的方式应保留给患有升主动脉瘤且主动脉瓣环正常的老年患者，而主动脉瓣再植入更适合患有导致主动脉根部瘤的遗传性疾病的年轻患者。本文总结了这两种手术已发表的经验。它们不再是实验性手术，应成为治疗主动脉根部瘤和伴有主动脉瓣关闭不全的升主动脉瘤患者的手术手段之一。
