Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Thorac Surg. 2013 Feb;95(2):635-41. doi: 10.1016/j.athoracsur.2012.09.021. Epub 2012 Nov 30.
This study aims to evaluate the early and long-term outcome of aortomitral fibrous body reconstruction with bovine pericardium in double-valve replacement.
Between January 1997 and December 2010, 30 consecutive patients (20 male patients) underwent aortomitral fibrous body reconstruction with double-valve replacement. Mean age was 52 ± 15 years (range, 9 to 77 years). The operative indications were infective endocarditis (IE) for 22 patients, small annuli for 5, and fragile annuli for 3. Bovine pericardium was used for all patients. Twelve patients (40%) needed an emergency operation for cardiogenic shock or septic emboli. The mean follow-up was 50.6 ± 43.5 months (range, 0 to 136 months).
There were 2 early (6.7%) and 5 late (16.7%) deaths. Early complications included bleeding in 6 patients, acute renal failure in 4, complete heart block in 3, and early reoperation due to paravalvular leakage in 1. Three patients with previous prosthetic valve endocarditis underwent late reoperations; specifically, redo valve replacements for 2 patients and heart transplantation for the other. Late dehiscence of prosthetic valve occurred in 1 patient with Behçet disease. In the IE patients, freedom from reoperation rate at 1 and 5 years was 95.5% and 84.8%, respectively, and the freedom from IE rate at 1 and 5 years was 94.7%. There was no statistical difference in overall survival rates between the patients with and without IE (p = 0.766).
The early and long-term results of aortomitral fibrous body reconstruction with double-valve replacement are promising, and bovine pericardium appears to have strong durability.
本研究旨在评估在双瓣置换术中使用牛心包进行主动脉瓣二尖瓣纤维体重建的早期和长期结果。
1997 年 1 月至 2010 年 12 月，连续 30 例患者（20 例男性患者）接受了主动脉瓣二尖瓣纤维体重建和双瓣置换术。平均年龄为 52 ± 15 岁（范围为 9 至 77 岁）。手术适应证为感染性心内膜炎（IE）22 例，小瓣环 5 例，瓣环脆弱 3 例。所有患者均使用牛心包。12 例（40%）因心源性休克或脓毒性栓塞而行急诊手术。平均随访时间为 50.6 ± 43.5 个月（范围为 0 至 136 个月）。
早期有 2 例（6.7%）和晚期有 5 例（16.7%）死亡。早期并发症包括 6 例出血、4 例急性肾功能衰竭、3 例完全性心脏传导阻滞和 1 例因瓣周漏而早期再次手术。3 例先前患有人工瓣膜心内膜炎的患者进行了晚期再次手术，其中 2 例为再次瓣膜置换，1 例为心脏移植。1 例患有贝切特病的患者发生人工瓣膜晚期裂开。在 IE 患者中，1 年和 5 年无再次手术率分别为 95.5%和 84.8%，1 年和 5 年无 IE 率分别为 94.7%。IE 患者和非 IE 患者的总生存率无统计学差异（p = 0.766）。
主动脉瓣二尖瓣纤维体重建与双瓣置换术的早期和长期结果是有希望的，牛心包具有较强的耐久性。
