Division of Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street 4N-453, Toronto, ON M5G 2C4, Canada.
Nat Rev Cardiol. 2013 Jul;10(7):375-86. doi: 10.1038/nrcardio.2013.72. Epub 2013 May 14.
The development of intraoperative transoesophageal echocardiography together with improved understanding of the functional anatomy of the aortic valve have allowed the design of several new conservative procedures, such as aortic valve-sparing operations, to treat patients with aortic root aneurysms or aortic insufficiency. The long-term results of these procedures have been excellent, and >90% of patients are free from reoperation on the aortic valve 10-15 years after surgery. Incompetent bicuspid aortic valves can also be repaired if the cusps are pliable and without calcification. Nevertheless, most patients with aortic valve disease, particularly those with aortic stenosis, need aortic valve replacement. Matching a patient to the type and size of prosthetic aortic valve is difficult, because of the limited durability of bioprosthetic valves and the need for lifelong anticoagulation with mechanical valves. Prosthesis-patient mismatch might not affect survival in most patients, but is a determinant of prognosis in patients with impaired ventricular function. Young adults with aortic stenosis, particularly women during childbearing years, can be treated with the Ross procedure. Finally, poor candidates for surgery who have aortic stenosis can now be treated with catheter-based aortic valve implantation but, in this article, the current status of aortic valve surgery is reviewed.
术中经食管超声心动图的发展以及对主动脉瓣功能解剖结构的深入了解，使得一些新的保守性手术得以设计，如主动脉瓣保留手术，以治疗主动脉根部瘤或主动脉瓣关闭不全的患者。这些手术的长期效果非常出色，手术后 10-15 年，超过 90%的患者无需再次进行主动脉瓣手术。如果主动脉瓣为二叶瓣且柔软无钙化，也可以对其进行修复。然而，大多数主动脉瓣疾病患者，特别是主动脉瓣狭窄患者，需要进行主动脉瓣置换。由于生物瓣的耐久性有限，以及机械瓣需要终身抗凝，因此为患者匹配合适的人工主动脉瓣类型和大小具有一定难度。瓣-患者不匹配可能不会影响大多数患者的生存率，但却是心室功能受损患者预后的决定因素。患有主动脉瓣狭窄的年轻成年人，特别是生育期的女性，可以采用 Ross 手术进行治疗。最后，对于那些不适合手术的严重主动脉瓣狭窄患者，现在可以采用经导管主动脉瓣植入术进行治疗，但本文主要回顾主动脉瓣手术的现状。
