Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Ann Thorac Surg. 2013 Dec;96(6):2090-4. doi: 10.1016/j.athoracsur.2013.07.056. Epub 2013 Sep 25.
Valve-sparing root replacement is controversial in patients with significant aortic insufficiency (AI) because the aortic valve cusps often require repair, which may potentially jeopardize long-term valve function. The purpose of this study was to evaluate valve function and left ventricular reverse remodeling in patients undergoing valve-sparing root replacement in the setting of significant AI.
A review of the Emory Aortic Surgery database between 2004 and 2012 identified 616 aortic root replacements. Of these procedures, 169 were performed for patients with 3+ or greater AI. Fifty-one patients (30%) underwent a David V procedure. Echocardiography was used to evaluate the degree of AI, left ventricular end-diastolic diameter, and left ventricular end-systolic diameter.
The mean echocardiographic follow-up was 18 ± 21 months (range, 1 to 89). Patients undergoing valve-sparing root replacement had an increase in ejection fraction (preoperative 51% ± 7% versus postoperative 57% ± 6%, p < 0.01) and a reduction in left ventricular end-diastolic diameter (preoperative 58 ± 8 mm versus postoperative 48 ± 6 mm, p < 0.01) and left ventricular end-systolic diameter (preoperative 40 ± 8 mm versus postoperative 32 ± 6 mm, p < 0.01). During the follow-up period, freedom from greater than 1+ AI was 96%, and freedom from aortic valve replacement was 98%. The addition of cusp repair did not represent a significant risk factor for recurrent postoperative AI (p = 0.21).
The David V technique produces significant left ventricular reverse remodeling and improved ventricular function in patients with chronic severe AI. Long-term data and close follow-up will be paramount in evaluating the durability of valve repair in this patient population.
在严重主动脉瓣关闭不全（AI）患者中，保留瓣膜的根部置换术存在争议，因为主动脉瓣瓣叶通常需要修复，这可能会危及长期的瓣膜功能。本研究的目的是评估在严重 AI 患者中进行保留瓣膜根部置换术时的瓣膜功能和左心室逆重构。
回顾 2004 年至 2012 年期间埃默里主动脉手术数据库，共确定了 616 例主动脉根部置换术。其中，169 例为 3+或更严重 AI 的患者进行。51 例（30%）患者行 David V 手术。超声心动图用于评估 AI 程度、左心室舒张末期直径和左心室收缩末期直径。
平均超声心动图随访时间为 18±21 个月（范围 1-89 个月）。行保留瓣膜根部置换术的患者射血分数增加（术前 51%±7%，术后 57%±6%，p<0.01），左心室舒张末期直径减小（术前 58±8mm，术后 48±6mm，p<0.01），左心室收缩末期直径减小（术前 40±8mm，术后 32±6mm，p<0.01）。在随访期间，大于 1+AI 的无复发率为 96%，主动脉瓣置换的无复发率为 98%。瓣叶修复的增加并不代表术后 AI 复发的显著危险因素（p=0.21）。
David V 技术可使慢性重度 AI 患者的左心室逆重构显著改善，并改善心室功能。长期数据和密切随访对于评估该患者人群中瓣膜修复的耐久性至关重要。
