Kalangos Afksendiyos, Myers Patrick O
Division of Cardiovascular Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
World J Pediatr Congenit Heart Surg. 2013 Oct;4(4):385-91. doi: 10.1177/2150135113498785.
Surgical management of aortic insufficiency in the young is problematic because of the lack of an ideal valve substitute. Potential advantages of aortic valve repair include low incidences of thromboembolism and endocarditis, avoiding conduit replacements, the maintenance of growth potential, and improved quality of life. Aortic valve repair is still far from fulfilling the three key factors that have allowed the phenomenal development of mitral valve repair (standardization, reproducibility, and stable long-term results); however, techniques of aortic valve repair have been refined, and subsets of patients amenable to repair have been identified. We have focused on the oldest technique of aortic valve repair, cusp extension, focusing on children with rheumatic aortic insufficiency. Among 77 children operated from 2003 to 2007, there was one early death from ventricular failure and one late death from sudden cardiac arrhythmia. During a mean follow-up of 12.8 ± 5.9 years, there were 16 (20.5%) reoperations on the aortic valve, at a median of 3.4 years (range, 2 months to 18.3 years) from repair. Freedom from aortic valve reoperation was 96.2% ± 2.2% at 1 year, 94.9% ± 2.5% at 2 years, 88.5% ± 3.6% at 5 years, 81.7% ± 4.4% at 10 years, 79.7% ± 4.8% at 15 years, and 76.2% ± 5.7% at 20 years. Although aortic cusp extension is technically more demanding, it remains particularly more suitable in the context of evolving rheumatic aortic insufficiency in children with a small aortic annulus as a bridge surgical approach to late aortic valve replacement with a larger valvular prosthesis.
由于缺乏理想的瓣膜替代品，年轻患者主动脉瓣关闭不全的外科治疗存在问题。主动脉瓣修复的潜在优势包括血栓栓塞和心内膜炎发生率低、避免人工血管置换、保留生长潜力以及改善生活质量。主动脉瓣修复仍远未达到使二尖瓣修复取得显著进展的三个关键因素（标准化、可重复性和稳定的长期效果）；然而，主动脉瓣修复技术已得到改进，并且已确定了适合修复的患者亚组。我们专注于主动脉瓣修复最古老的技术——瓣叶延长术，重点关注患有风湿性主动脉瓣关闭不全的儿童。在2003年至2007年接受手术的77名儿童中，有1例因心室衰竭早期死亡，1例因心源性猝死晚期死亡。在平均12.8±5.9年的随访期间，有16例（20.5%）在修复后中位时间3.4年（范围2个月至18.3年）进行了主动脉瓣再次手术。主动脉瓣再次手术的无复发生存率在1年时为96.2%±2.2%，2年时为94.9%±2.5%，5年时为88.5%±3.6%，10年时为81.7%±4.4%，15年时为79.7%±4.8%，20年时为76.2%±5.7%。尽管主动脉瓣叶延长术在技术上要求更高，但对于主动脉瓣环较小、患有风湿性主动脉瓣关闭不全且病情不断发展的儿童来说，它仍然特别适合作为一种过渡性手术方法，以便后期用更大的瓣膜假体进行主动脉瓣置换。
