De Paulis Ruggero, Chirichilli Ilaria, Scaffa Raffaele, Weltert Luca, Maselli Daniele, Salica Andrea, Guerrieri Wolf Lorenzo, Bellisario Alessandro, Chiariello Luigi
Cardiac Surgery Department, European Hospital, Rome, Italy.
Cardiac Surgery Department, European Hospital, Rome, Italy.
J Thorac Cardiovasc Surg. 2016 Jan;151(1):112-9. doi: 10.1016/j.jtcvs.2015.08.026. Epub 2015 Aug 13.
Aortic valve reimplantation is the most commonly used technique to spare the aortic valve. Long-term results data are scarce and available only with the use of standard straight graft. We examined the long-term results of reimplantation of the aortic valve using a graft incorporating sinuses of Valsalva.
From May 2000 to December 2014, 124 patients had an aortic valve reimplanted into a graft with sinuses of Valsalva. The mean age was 53 ± 13 years and the majority were men (87%). Marfan syndrome was present in 21 patients (17%) and 12% had a bicuspid valve. Patients were prospectively followed by means of transthoracic echocardiography. The mean follow-up was 63 ± 52 months.
Overall survival at 5, 10, and 13 years was 94.4% ± 2.2%, 90.5% ± 4.4%, and 81.4% ± 7.3%, respectively. Six patients required reoperation within a time frame of 6 to 96 months. None of the patients died at reoperation. Freedom from reoperation was 95.4% ± 2.3% at 5 years and 90.1% ± 4.3% at 10 and 13 years. All patients who needed reoperation had surgery during the first 5 years. Three patients had residual aortic insufficiency >2. Considering also all patients who underwent reoperation because of aortic insufficiency, freedom from moderate to severe residual aortic insufficiency was 94.1% ± 2.6% at 5 years, and 87.1% ± 4.7% at 10 and 13 years.
The majority of patients who had their valve reimplanted in a graft with sinuses continue to perform well after 10 years.
主动脉瓣再植入术是保留主动脉瓣最常用的技术。长期结果数据稀缺，且仅在使用标准直型移植物时可得。我们研究了使用包含主动脉窦的移植物进行主动脉瓣再植入术的长期结果。
2000年5月至2014年12月，124例患者接受了将主动脉瓣再植入包含主动脉窦的移植物的手术。平均年龄为53±13岁，大多数为男性（87%）。21例患者（17%）患有马凡综合征，12%有二叶式主动脉瓣。通过经胸超声心动图对患者进行前瞻性随访。平均随访时间为63±52个月。
5年、10年和13年的总生存率分别为94.4%±2.2%、90.5%±4.4%和81.4%±7.3%。6例患者在6至96个月内需要再次手术。再次手术时无患者死亡。5年时再次手术的自由度为95.4%±2.3%，10年和13年时为90.1%±4.3%。所有需要再次手术的患者均在最初5年内接受了手术。3例患者有残余主动脉瓣关闭不全>2级。考虑到所有因主动脉瓣关闭不全而接受再次手术的患者，5年时无中度至重度残余主动脉瓣关闭不全的自由度为94.1%±2.6%，10年和13年时为87.1%±4.7%。
大多数将瓣膜再植入包含主动脉窦的移植物的患者在10年后仍表现良好。
