Mazzitelli Domenico, Nöbauer Christian, Rankin J Scott, Badiu Catalin C, Dorfmeister Magdalena, Crooke Philip S, Wagner Anke, Schreiber Christian, Lange Rüdiger
Department of Cardiovascular Surgery, Technische Universität München, Deutsches Herzzentrum München, Munich, Germany.
Eur J Cardiothorac Surg. 2014 Mar;45(3):426-30. doi: 10.1093/ejcts/ezt407. Epub 2013 Aug 19.
Surgery for aortic root aneurysm without valve stenosis is increasingly being transformed from the Bentall procedure to valve-sparing aortic root remodelling or reimplantation. In this report, a new repair option is explored, with full functional 'restoration' of the aortic root complex using a geometric annuloplasty ring, leaflet repair, and sinus/ascending aortic replacement with a Valsalva graft.
The geometric annuloplasty ring restores elliptical annular shape and size in patients with tri-leaflet aortic insufficiency (AI). The ring mounts the three valve commissures on 10° outwardly flaring posts, and facilitates required leaflet procedures. In clinical application, the device has been effective in achieving stable AI reduction with low valve gradients. In this report, 6 patients with aortic root aneurysms and moderate/severe AI were managed with valve repair using the annuloplasty device and leaflet reconstruction, and then concomitant sinus and ascending aortic graft replacement with coronary implantation.
In the 6 initial root aneurysm patients, there were no in-hospital mortalities, procedural conversions, or valve-related complications. Preoperative AI grade was 2-4 and fell to 0-1 postoperatively. Post-repair mean systolic gradients ranged from 7 to 12 mmHg, and all patients had stable intermediate-term valve function.
Aortic root restoration using a geometric annuloplasty ring and Valsalva graft may be the most physiological method of aortic valve repair and root replacement. Even with severe leaflet derangements, valve sparing can be achieved with good competence and potentially stable long-term results. This technique could assist in extending valve sparing into most categories of aortic root disease.
Patients were managed as part of a Phase I (ClinicalTrials.gov Identifier: NCT01400841), supported by BioStable Science and Engineering (BSE), Austin, TX, USA; www.biostable-s-e.com.
对于无瓣膜狭窄的主动脉根部瘤手术，正越来越多地从Bentall手术转变为保留瓣膜的主动脉根部重塑或再植入术。在本报告中，探索了一种新的修复选择，即使用几何瓣环成形术环、瓣叶修复以及用窦管型移植物置换窦部/升主动脉，对主动脉根部复合体进行完全功能性“修复”。
几何瓣环成形术环可恢复三叶式主动脉瓣关闭不全（AI）患者的椭圆形瓣环形状和大小。该环将三个瓣膜交界安装在向外呈10°扩张的柱上，并便于进行所需的瓣叶手术。在临床应用中，该装置已有效地实现了稳定的AI减轻且瓣膜压差较低。在本报告中，6例主动脉根部瘤合并中度/重度AI患者采用瓣环成形术装置进行瓣膜修复和瓣叶重建，然后同期进行窦部和升主动脉移植物置换及冠状动脉植入。
在6例最初的根部瘤患者中，无住院死亡、手术中转或瓣膜相关并发症。术前AI分级为2 - 4级，术后降至0 - 1级。修复后平均收缩压差为7至12 mmHg，所有患者中期瓣膜功能稳定。
使用几何瓣环成形术环和窦管型移植物进行主动脉根部修复可能是主动脉瓣修复和根部置换最符合生理的方法。即使瓣叶严重紊乱，也可实现保留瓣膜，瓣膜功能良好且可能获得稳定的长期效果。该技术可能有助于将保留瓣膜扩展至大多数类型的主动脉根部疾病。
患者作为I期试验（ClinicalTrials.gov标识符：NCT01400841）的一部分接受治疗，由美国得克萨斯州奥斯汀的BioStable Science and Engineering（BSE）公司支持；网址：www.biostable-s-e.com。
