Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France.
Vascular Surgery Unit, Hopital Foch, Suresnes, France.
J Thorac Cardiovasc Surg. 2017 May;153(5):1033-1042. doi: 10.1016/j.jtcvs.2016.12.031. Epub 2017 Jan 11.
Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied.
Data were collected from the Aortic Valve repair InternATiOnal Registry. Preoperative aortic insufficiency grade 3 or greater was present in 79 patients (44.7%). The valve was bicuspid in 59 patients (33.3%). External annuloplasty was performed through a homemade Dacron ring (56) or a dedicated expansible aortic ring (121).
Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1 ± 36.4 months. For the whole series, freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency grade 2 or greater, and major adverse valve-related events were 89.5%, 90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for tricuspid and bicuspid valves. Since 2007, systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment, significantly increased 7-year freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, and major adverse valve-related events up to 99.1% ± 0.9% (P = .017), 100% (P = .026), and 96.3% ± 1.8% (P = .035), respectively, whereas freedom from aortic insufficiency grade 2 or greater remained unaffected (78.1% ± 7.6%). Calibrated annuloplasty and effective height assessment were identified as protective factors from reoperation: hazard ratio, 0.13; 95% confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .044, respectively.
The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.
尽管重塑技术提供了最具动态的瓣膜保留性根部替换，但扩张的瓣环（>25 毫米）是手术失败的一个风险因素。主动脉瓣环成形术旨在减小瓣环直径，从而增加对合高度以保护修复。研究了 177 例采用重塑和外部主动脉环瓣环成形术的患者的结果。
从主动脉瓣修复国际注册中心收集数据。术前主动脉瓣关闭不全 3 级或更高级别存在于 79 例患者（44.7%）中。二叶瓣 59 例（33.3%）。外部瓣环成形术通过自制的 Dacron 环（56 例）或专用可扩张主动脉环（121 例）进行。
30 天死亡率为 2.9%（5 例）。平均随访 41.1±36.4 个月。对于整个系列，瓣膜相关再手术、3 级或更高级别的主动脉瓣关闭不全、2 级或更高级别的主动脉瓣关闭不全以及主要不良瓣膜相关事件的无事件生存率分别为 89.5%、90.5%、77.4%和 86.6%，在 7 年时，三尖瓣和二叶瓣的结果相似。自 2007 年以来，系统使用校准可扩张环瓣环成形术，随后在 1 年后系统评估瓣叶有效高度，显著提高了瓣膜相关再手术、3 级或更高级别的主动脉瓣关闭不全以及主要不良瓣膜相关事件的 7 年无事件生存率，达到 99.1%±0.9%（P=0.017）、100%（P=0.026）和 96.3%±1.8%（P=0.035），而 2 级或更高级别的主动脉瓣关闭不全不受影响（78.1%±7.6%）。校准瓣环成形术和有效高度评估被确定为再手术的保护因素：风险比分别为 0.13；95%置信区间，0.02-1.06；P=0.057 和风险比为 0.11；95%置信区间，0.01-0.95；P=0.044。
采用校准可扩张主动脉环瓣环成形术和瓣叶有效高度评估的标准重塑根部修复术可改善瓣膜修复效果。
