Ozaki Shigeyuki, Kawase Isamu, Yamashita Hiromasa, Uchida Shin, Takatoh Mikio, Hagiwara So, Kiyohara Nagaki
Department of Cardiovascular Surgery, Toho University Ohashi Medical Center.
Circ J. 2015;79(7):1504-10. doi: 10.1253/circj.CJ-14-1092. Epub 2015 Mar 30.
To determine the feasibility of original aortic valve reconstruction (AVRec) for patients with aortic stenosis (AS), 416 consecutive cases were reviewed.
AVRecs for AS were performed for 416 patients from April 2007 through April 2013. All 416 patients were retrospectively reviewed. One hundred and fourteen patients had bicuspid valves and 16 had unicuspid valves. There were 182 men and 234 women. Mean age was 71.2±12.0 years old. On preoperative echocardiography, peak pressure gradient averaged 79.0±33.6 mmHg. Surgical annular diameter was 20.1±2.8 mm. The procedure is based on independent tricuspid replacement by autologous pericardium using original sizing apparatus and template. There was no conversion to prosthetic valve replacement. There were 8 in-hospital mortalities due to non-cardiac cause. On postoperative echocardiography, peak pressure gradient averaged 21.2±10.7 mmHg 1 week after surgery and 14.3±5.0 mmHg 5.5 years after surgery. Four reoperations were done for infective endocarditis. The other 412 patients had less than mild regurgitation. No thrombo-embolic events were recorded. The mean follow-up period was 25.2±17.5 months. Freedom from reoperation was 96.7% with 73-month follow-up.
Medium-term results were excellent. Original AVRec was feasible for the patients with AS. Long-term data will be presented in the future.
为确定主动脉瓣重建术（AVRec）用于主动脉瓣狭窄（AS）患者的可行性，回顾了416例连续病例。
2007年4月至2013年4月对416例AS患者实施了AVRec。对所有416例患者进行了回顾性分析。114例患者为二叶式主动脉瓣，16例为单叶式主动脉瓣。男性182例，女性234例。平均年龄为71.2±12.0岁。术前超声心动图检查显示，峰值压力阶差平均为79.0±33.6 mmHg。手术瓣环直径为20.1±2.8 mm。该手术基于使用原始尺寸测量装置和模板，采用自体心包独立进行三尖瓣置换。未转为人工瓣膜置换。有8例因非心脏原因导致的住院死亡。术后超声心动图检查显示，术后1周峰值压力阶差平均为21.2±10.7 mmHg，术后5.5年为14.3±5.0 mmHg。因感染性心内膜炎进行了4次再次手术。其他412例患者反流程度小于轻度。未记录到血栓栓塞事件。平均随访期为25.2±17.5个月。随访73个月时，再次手术自由度为96.7%。
中期结果良好。原始AVRec对AS患者可行。未来将公布长期数据。
