David Tirone E
Division of Cardiovascular Surgery of Peter Munk Cardiac Centre at Toronto, General Hospital; Department of Surgery, University of Toronto, Toronto, Ontario, Canada..
Semin Thorac Cardiovasc Surg. 2014 Autumn;26(3):231-8. doi: 10.1053/j.semtcvs.2014.10.002. Epub 2014 Nov 11.
It has been more than 2 decades since aortic valve-sparing operations were introduced to preserve the aortic valve in patients with aortic root aneurysm. Remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, mostly because it preserves the aortic annulus movement during the cardiac cycle. However, several comparative studies have shown that reimplantation of the aortic valve has provided more stable aortic valve function than remodeling of the aortic root. This difference in outcomes is largely because of patients׳ selection. Remodeling of the aortic root has been associated with high failure rates in patients with aneurysms associated with genetic syndromes and bicuspid aortic valves with dilated aortic annulus, but it has provided excellent long-term results in older patients with aortic root aneurysms secondary to ascending aortic aneurysms and normal aortic annulus. Thus, both techniques are useful in preserving the aortic valve. With either technique, restoration of normal aortic annulus and cusp geometry is the single most important technical aspect of these operations. In addition to having a competent valve with no or trivial aortic insufficiency at the end of the operation, there must be no cusp prolapse and the coaptation level of the cusps has to be well above the level of the nadir of the aortic annulus.
自主动脉瓣保留手术被引入以在主动脉根部瘤患者中保留主动脉瓣以来，已经过去了20多年。主动脉根部重塑在生理上优于主动脉瓣再植入，主要是因为它在心动周期中保留了主动脉瓣环的运动。然而，几项比较研究表明，主动脉瓣再植入比主动脉根部重塑提供了更稳定的主动脉瓣功能。这种结果差异很大程度上是由于患者的选择。主动脉根部重塑与患有遗传综合征相关动脉瘤和主动脉瓣环扩张的二叶式主动脉瓣患者的高失败率有关，但它在继发于升主动脉瘤且主动脉瓣环正常的老年主动脉根部瘤患者中提供了出色的长期结果。因此，这两种技术在保留主动脉瓣方面都很有用。无论采用哪种技术，恢复正常的主动脉瓣环和瓣叶形态都是这些手术最重要的技术方面。除了在手术结束时拥有一个功能正常、无或仅有轻微主动脉瓣关闭不全的瓣膜外，还必须没有瓣叶脱垂，并且瓣叶的对合水平必须远高于主动脉瓣环最低点的水平。
