Division of Cardiac Surgery, University Hospital, Pisa, Italy.
Division of Cardiology, University Hospital, Pisa, Italy.
J Thorac Cardiovasc Surg. 2014 Mar;147(3):977-83. doi: 10.1016/j.jtcvs.2013.02.074. Epub 2013 Mar 27.
Enlargement of the aortic annulus may be required during aortic valve replacement to avoid patient-prosthesis mismatch. We reviewed patients with enlargement of the aortic annulus with the aim of assessing the stability of the procedure by means of echocardiographic and angio-computed tomography studies.
A series of 53 consecutive patients underwent aortic valve replacement and enlargement of the aortic annulus from 1994 to 2012. The mean age was 68 ± 11 years (range, 29-84 years), and 85% (45 patients) were female. The predominant valvular lesion was aortic stenosis. The mean logistic European System for Cardiac Operative Risk Evaluation was 11.2 ± 13.0. Enlargement of the aortic annulus was performed by extending the aortotomy incision to separate the commissure between the left and noncoronary sinuses into the anterior mitral leaflet and closing the resulting defect with an adequately tailored patch of bovine pericardium.
Hospital mortality was 2%, with 20 late deaths mostly due to noncardiac causes. At a maximum follow-up of 18 years (mean, 8.9 ± 5.0 years), actuarial survival is 37% ± 9%. No cases of severe patient-prosthesis mismatch were observed, and only 2 patients had moderate patient-prosthesis mismatch. At discharge, the mean aortic root diameter was 30.0 ± 2.3 mm and the mean diameter at the sinotubular junction was 31.5 ± 5.0 mm. At follow-up, the mean aortic root diameter was 31.0 ± 3.4 mm and the mean diameter at the sinotubular junction was 31.7 ± 4.5 mm (P = not significant) with no cases of late aneurysm formation on angio-computed tomography.
Enlargement of the aortic annulus is a safe and effective procedure and should be indicated in patients with a small aortic annulus; particularly, it should be considered to prevent patient-prosthesis mismatch and its potential deleterious long-term effects.
在主动脉瓣置换术中，可能需要扩大主动脉瓣环以避免患者-假体不匹配。我们回顾了主动脉瓣环扩大的患者，旨在通过超声心动图和血管计算机断层扫描研究评估该手术的稳定性。
1994 年至 2012 年，连续 53 例患者接受了主动脉瓣置换术和主动脉瓣环扩大术。平均年龄为 68±11 岁（范围 29-84 岁），85%（45 例）为女性。主要瓣膜病变为主动脉瓣狭窄。平均欧洲心脏手术风险评估系统逻辑指数为 11.2±13.0。通过扩大主动脉切开术切口，将左冠状动脉窦和无冠状动脉窦之间的交界分离到前二尖瓣叶，并使用适当裁剪的牛心包补片封闭由此产生的缺陷，从而扩大主动脉瓣环。
住院死亡率为 2%，20 例晚期死亡主要由非心脏原因引起。最长随访 18 年（平均 8.9±5.0 年）， actuarial 生存率为 37%±9%。未观察到严重的患者-假体不匹配病例，仅有 2 例患者存在中度患者-假体不匹配。出院时，主动脉根部直径平均为 30.0±2.3mm，窦管交界处直径平均为 31.5±5.0mm。随访时，主动脉根部直径平均为 31.0±3.4mm，窦管交界处直径平均为 31.7±4.5mm（P 无显著差异），血管计算机断层扫描未发现晚期动脉瘤形成。
主动脉瓣环扩大术是一种安全有效的方法，应在主动脉瓣环较小的患者中进行；特别是应考虑避免患者-假体不匹配及其潜在的长期不良影响。
