Dumani Selman, Likaj Ermal, Dibra Laureta, Beca Vera, Kuci Saimir, Refatllari Ali
University Hospital Centre "Mother Theresa", Service of Cardiac Surgery, Tirana, Albania.
Obstetric Gynaecologic Hospital "Queen Geraldine", Tirana, Albania.
Open Access Maced J Med Sci. 2017 Mar 15;5(1):23-26. doi: 10.3889/oamjms.2017.006. Epub 2017 Jan 31.
Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country.
During the period January 2010 -January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch. Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge.
In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose. In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42. We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology. The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow-up, we had no death, and all patients had very good quality of life.
Aortic valve annulus enlargement can be used with very good early and late results with the final goal to increase the potential benefit of the patient from surgery of aortic valve.
人工瓣膜与患者不匹配（PPM）在主动脉瓣手术中很常见。尽管已对这一现象对主动脉瓣手术结果的影响展开讨论，但该问题的处理仍是此类手术的主要议题之一。解决方法之一是扩大主动脉瓣环。本研究的主要主题是评估该技术在我国的早期和长期效果。
在2010年1月至2015年1月期间，641例患者接受了主动脉瓣手术。其中10例患者根据马努吉安技术进行了主动脉瓣环扩大，以避免严重的人工瓣膜与患者不匹配。手术死亡率和围手术期并发症（低心排血量、肺部并发症等）被视为早期效果的指标。生存率、根据纽约心脏协会（NYHA）分级的临床表现、生活质量是评估长期效果的指标。术前和术后的超声心动图数据也用于评估我们的结果。我们从医院登记记录以及出院后的定期临床随访和超声检查中收集数据。
在我们的研究组中，10例患者中有6例被诊断为主动脉瓣狭窄，2例有主动脉瓣反流，2例为混合性瓣膜病变。4例患者同时进行了心脏手术，二尖瓣手术或冠状动脉旁路移植术（CABG）。在所有病例中，主动脉瓣病变均为主要诊断。术前超声心动图检查时平均跨瓣压差为54.3±6.42。术后早期或晚期均无死亡病例。只有1例患者因肺部病变出现肺部并发症且需要长时间呼吸支持。该患者还出现了低心排血量和伤口感染。术后早期人工瓣膜平均压差为16.2±3.44，术后晚期为15.9±4.3。没有患者出现严重的人工瓣膜与患者不匹配。平均随访时间为49±20.26个月。随访期间，无死亡病例，所有患者生活质量均非常好。
主动脉瓣环扩大术的早期和晚期效果良好，最终目标是增加患者从主动脉瓣手术中获得的潜在益处。
