Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2014 Apr;97(4):1227-34. doi: 10.1016/j.athoracsur.2013.10.071. Epub 2014 Jan 10.
At our institution, type I bicuspid aortic valve (BAV) patients with aortic insufficiency (AI) who are candidates for valve preservation are stratified into two groups by aortic root pathology: nonaneurysmal root undergoing primary cusp repair+subcommissural annuloplasty (repair group) vs aneurysmal root undergoing primary cusp repair+root reimplantation (reimplantation group). We report outcomes of this surgical reconstructive strategy for the repaired type I BAV.
A retrospective review was performed of 71 patients with a type I BAV undergoing primary valve repair from 2005 to 2012. The repair group (n=40) underwent annular stabilization by subcommissural annuloplasty, and the reimplantation group (n=31) underwent robust annular stabilization provided by root reimplantation.
Preoperative characteristics and root anatomy were similar, except for increased root dimensions in the reimplantation group (p<0.001). Mortality, stroke, valve reoperation, and pacemaker requirement were zero in both groups. Postoperative peak (19±10 vs 11±5 mm Hg, p<0.001) and mean gradients (10±5 vs 5±3 mm Hg, p<0.001) favored root reimplantation. Freedom from AI greater than 1+ was 100% in both groups. Mean follow-up was 40 months in the reimplantation group and 38 months in the repair group. At 5 years, overall survival was 100% in both groups. Freedom from aortic reoperation and AI exceeding 2+ were similar in both groups. Freedom from AI exceeding 1+ was significantly better in the reimplantation group (92%±6% vs 62%±10%, p=0.03). The 2-year peak (14±6 vs 19±9 mm Hg, p=0.009) and mean (7±4 vs 11±5 mm Hg, p=0.001) gradients favored root reimplantation.
Root stabilization with the reimplantation technique significantly improves the durability of the repaired type I BAV compared with subcommissural annuloplasty. It also provides improved and sustained valve mobility (transvalvular gradients).
在我们的机构中，有主动脉瓣关闭不全（AI）的 I 型二叶式主动脉瓣（BAV）患者，如果适合保留瓣膜，则根据主动脉根部病变将其分为两组：非动脉瘤性根部行主瓣叶修复+瓣下环成形术（修复组）与动脉瘤性根部行主瓣叶修复+根部再植术（再植组）。我们报告了这种修复 I 型 BAV 的外科重建策略的结果。
对 2005 年至 2012 年间接受初次瓣叶修复的 71 例 I 型 BAV 患者进行回顾性分析。修复组（n=40）行瓣下环成形术稳定瓣环，再植组（n=31）行根部再植术提供牢固的瓣环稳定。
两组患者的术前特征和根部解剖结构相似，但再植组的根部尺寸增大（p<0.001）。两组患者的死亡率、卒中和瓣叶再手术以及起搏器需求均为零。术后峰值（19±10 比 11±5mmHg，p<0.001）和平均跨瓣压差（10±5 比 5±3mmHg，p<0.001）均有利于根部再植术。两组患者的 AI 均大于 1+的比例均为 100%。再植组的平均随访时间为 40 个月，修复组为 38 个月。5 年时，两组患者的总生存率均为 100%。两组患者主动脉瓣再手术和 AI 大于 2+的比例相似。AI 大于 1+的无事件生存率再植组显著优于修复组（92%±6%比 62%±10%，p=0.03）。再植组的 2 年峰值（14±6 比 19±9mmHg，p=0.009）和平均跨瓣压差（7±4 比 11±5mmHg，p=0.001）均有利于根部再植术。
与瓣下环成形术相比，根部再植术可显著提高修复的 I 型 BAV 的耐用性，并提供更好的、持续的瓣叶活动度（跨瓣压差）。
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