Izzat Mohammad Bashar, Hamzeh Khaled, Mahmoud Fadi, Bakour Mohammad M
Damascus University Cardiac Surgery Hospital, Damascus, Syria
Damascus University Cardiac Surgery Hospital, Damascus, Syria.
Interact Cardiovasc Thorac Surg. 2015 Jul;21(1):77-80. doi: 10.1093/icvts/ivv081. Epub 2015 Apr 4.
Wider adoption of aortic valve repair procedures is held up by the difficulty in recognizing the exact alterations that are responsible for aortic valve insufficiency. New aortic cusp sizers were developed to assist in aortic valve assessment in the operating theatre. Our objectives were to examine the efficacy of the aortic cusp sizers in establishing the functional classification of aortic valve insufficiency, and to report the midterm outcome in a group of patients who had undergone aortic valve repair guided by this device.
A prospective clinical study was performed involving 33 consecutive patients (18 males, age range: 8-74 years) with severe aortic valve insufficiency (mean severity: 3.4 ± 0.5). The aortic cusp sizers were used as a template to identify existing cusp and root alterations. Consequently, the functional classification of aortic insufficiency was determined, and the appropriate techniques of aortic valve repair were implemented.
Aortic valve repair was successful in all patients. Procedures performed were 37 functional aortic annulus corrections, 9 cusp free-edge plications, 2 cusp repairs with autologous pericardium, 9 replacements of the ascending aorta and 2 reimplantation procedures. At a mean follow-up time of 18.3 ± 13.7 months, 1 patient underwent aortic valve replacement for recurrent aortic valve regurgitation, while aortic valve function remained stable in 32 patients, with aortic insufficiency <1+ in 27 (84.4%) patients and 1-1.5 in 5 (15.6%) patients, and no significant gradients across the aortic valves.
The aortic cusp sizers are valuable in establishing the functional classification of aortic insufficiency, and can guide implementation of aortic valve repair techniques successfully. This approach is analogous to that accredited for the success and wide adoption of mitral valve repair techniques, and is likely to assist in increasing the percentage of aortic valves that are repaired when compared with current practice.
主动脉瓣修复手术的更广泛应用因难以识别导致主动脉瓣关闭不全的确切改变而受阻。新型主动脉瓣叶尺寸测量器已被开发出来,以协助在手术室中进行主动脉瓣评估。我们的目的是检验主动脉瓣叶尺寸测量器在确定主动脉瓣关闭不全功能分类方面的有效性,并报告一组在该装置引导下接受主动脉瓣修复的患者的中期结果。
进行了一项前瞻性临床研究,纳入33例连续的严重主动脉瓣关闭不全患者(18例男性,年龄范围:8 - 74岁,平均严重程度:3.4±0.5)。将主动脉瓣叶尺寸测量器用作模板来识别现有的瓣叶和根部改变。因此,确定了主动脉瓣关闭不全的功能分类,并实施了适当的主动脉瓣修复技术。
所有患者的主动脉瓣修复均成功。实施的手术包括37例功能性主动脉瓣环矫正、9例瓣叶游离缘折叠、2例自体心包瓣叶修复、9例升主动脉置换和2例再植入手术。平均随访时间为18.3±13.7个月,1例患者因复发性主动脉瓣反流接受了主动脉瓣置换,而32例患者的主动脉瓣功能保持稳定,27例(84.4%)患者的主动脉瓣关闭不全<1+级,5例(15.6%)患者为1 - 1.5级,且主动脉瓣跨瓣压差无显著变化。
主动脉瓣叶尺寸测量器在确定主动脉瓣关闭不全的功能分类方面很有价值,并且能够成功地指导主动脉瓣修复技术的实施。这种方法类似于二尖瓣修复技术成功并广泛应用所认可的方法,并且与当前的做法相比,可能有助于提高主动脉瓣修复的比例。