Matsuzaki Kanji, Kudo Yohei, Ikeda Akihiko, Konishi Taisuke, Jikuya Tomoaki
Department of Cardiovascular Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
Gen Thorac Cardiovasc Surg. 2016 Feb;64(2):87-92. doi: 10.1007/s11748-015-0600-5. Epub 2015 Nov 17.
We adopted an anterior longitudinal aortotomy in some cases of aortic valve replacement (AVR), and report them here. The potential of this method is also discussed.
We analyzed the data on 24 patients (75.5 ± 7.8 years of age) who had undergone AVR through anterior longitudinal aortotomy. The indications for surgery were prosthetic valve complication in 5 patients, aortic stenosis (AS) with left ventricular outflow tract stenosis (LVOTS) in 16 patients, and aortic regurgitation with moderately dilated ascending aorta in 3 patients. The Konno procedure was performed in 6 cases with small aortic annuli. A longitudinal aortotomy was made at the aortic root along the left side of the right coronary ostium, and extended beyond the right coronary annulus to the interventricular septum as needed.
Bioprostheses (21.1 ± 1.7 mm) were used in 23 patients and a 21-mm mechanical valve for one (a 59-year-old man). One high-risk patient died of low output syndrome, leading to a mortality rate of 4.2 %. All other patients recovered well, though atrioventricular block occurred in 2 cases.
Anterior longitudinal aortotomy provides a good field of vision at the aortic annulus and the flexibility to develop into anterior annular enlargement. Major indications for this approach are small sino-tubular junction and very small aortic annulus. This approach could be an attractive option in AVR for cases of AS with small aortic annuli and LVOTS. It could also be useful for AVR cases with moderately dilated ascending aorta requiring aortoplasty.
我们在一些主动脉瓣置换术（AVR）病例中采用了主动脉前纵切口，并在此报告相关情况。同时也讨论了该方法的潜力。
我们分析了24例（年龄75.5±7.8岁）通过主动脉前纵切口进行AVR手术患者的数据。手术适应证包括5例人工瓣膜并发症、16例合并左心室流出道狭窄（LVOTS）的主动脉狭窄（AS）以及3例合并升主动脉中度扩张的主动脉瓣关闭不全。6例主动脉瓣环较小的患者进行了Konno手术。在主动脉根部沿右冠状动脉开口左侧做一纵向主动脉切口，并根据需要延伸至右冠状动脉瓣环以外直至室间隔。
23例患者使用生物瓣膜（21.1±1.7mm），1例（一名59岁男性）使用21mm机械瓣膜。1例高危患者死于低心排血量综合征，死亡率为4.2%。所有其他患者恢复良好，不过有2例出现房室传导阻滞。
主动脉前纵切口可提供良好的主动脉瓣环视野，并具有发展为前瓣环扩大的灵活性。该方法的主要适应证是窦管交界小和主动脉瓣环非常小。对于合并小主动脉瓣环和LVOTS的AS病例，这种方法在AVR中可能是一个有吸引力的选择。对于需要进行主动脉成形术的合并升主动脉中度扩张的AVR病例也可能有用。
