Ando Masahiko, Yamauchi Haruo, Morota Tetsuro, Taketani Tsuyoshi, Shimada Shogo, Nawata Kan, Umeki Akihide, Ono Minoru
The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan.
The University of Tokyo, Department of Cardiac Surgery, Tokyo, Japan.
J Cardiol. 2016 Jan;67(1):86-91. doi: 10.1016/j.jjcc.2015.03.014. Epub 2015 Apr 25.
In valve-sparing aortic root replacement (VSARR), how to reproduce Valsalva sinus has been an issue. In the original David V procedure, they put plication stitches at sinotubular junction level, although the reefing effect is limited and distal graft remains larger than native. Other modified techniques are two-grafts technique and ready-made Valsalva graft. However, the former needs graft-graft anastomosis and may not be cost-effective, while in the latter, the shape of sinus is fixed and minor adjustment is difficult. David V University of Tokyo modification (David V-UT) is our original solution to that, creating pseudosinus with one straight graft by longitudinal size-reduction running sutures above each pseudosinus. The purpose of the present study is to investigate long-term outcome of David V-UT.
We analyzed 59 David V-UT patients from February 2004 to February 2013 and long-term outcomes were investigated by Kaplan-Meier methods. Risk factors for adverse events "death or recurrent aortic insufficiency (AI) with or without aortic valve reoperation" were analyzed by using Cox proportional hazard models.
Mean age was 33.1±14.5 years, and 38 patients (64%) were male. Marfan syndrome (MFS) accounts for 47 patients (80%). Only one patient was with bicuspid aortic valve. No in-hospital mortality was observed. Mean follow-up was 4.9±2.4 years. Estimated survival was 94.0±3.4% at 5 years. Freedoms from aortic valve reoperation and recurrent AI greater than mild were 95.7±3.0% and 88.9±4.7% at 5 years, respectively. In Cox proportional hazard analysis, preoperative AI greater than mild and Z score of annular diameter were significant risks for adverse events (p=0.027 and 0.045, hazard ratio 6.084 and 1.432, 95% C.I. 1.225-30.21 and 1.008-2.035, respectively).
Even in Marfan-characterized population, David V-UT provided satisfactory long-term outcome, comparable to other VSARR modifications. It is simple but can freely reproduce trilobed sinus with one straight graft.
在保留瓣膜的主动脉根部置换术（VSARR）中，如何重现主动脉窦一直是个问题。在最初的大卫V手术中，他们在窦管交界水平放置折叠缝线，尽管折叠效果有限，且远端移植物仍比天然的大。其他改良技术包括双移植物技术和预制主动脉窦移植物。然而，前者需要移植物-移植物吻合，可能不具有成本效益，而在后者中，窦的形状是固定的，微调很困难。大卫V东京大学改良术（David V-UT）是我们针对此问题的原创解决方案，通过在每个假窦上方进行纵向尺寸缩减连续缝合，用一根直的移植物创建假窦。本研究的目的是调查David V-UT的长期结果。
我们分析了2004年2月至2013年2月期间的59例David V-UT患者，并采用Kaplan-Meier方法调查长期结果。使用Cox比例风险模型分析不良事件“死亡或复发性主动脉瓣关闭不全（AI），无论是否进行主动脉瓣再次手术”的风险因素。
平均年龄为33.1±14.5岁，38例（64%）为男性。马凡综合征（MFS）占47例（80%）。只有1例患者为二叶式主动脉瓣。未观察到院内死亡。平均随访时间为4.9±2.4年。5年时的估计生存率为94.0±3.4%。5年时主动脉瓣再次手术和复发性AI大于轻度的自由度分别为95.7±3.0%和88.9±4.7%。在Cox比例风险分析中，术前AI大于轻度和环直径Z评分是不良事件的显著风险因素（p = 0.027和0.045，风险比分别为6.084和1.432，95%置信区间分别为1.225 - 30.21和1.008 - 2.035）。
即使在以马凡综合征为特征的人群中，David V-UT也提供了令人满意的长期结果，与其他VSARR改良术相当。它很简单，但可以用一根直的移植物自由重现三叶形窦。
