Beckerman Ziv, Leshnower Bradley G, McPherson LaRonica, Binongo Jose N, Lasanajak Yi, Chen Edward P
Division of Cardiothoracic Surgery, Department of Surgery, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, GA, USA.
J Vis Surg. 2018 May 10;4:98. doi: 10.21037/jovs.2018.04.05. eCollection 2018.
Biologic valved-conduits avoids the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of the sinuses of Valsalva into the neoaortic root can improve the function and longevity of stentless valves. We report our experience in performing the Bentall procedure with a self-prefabricated composite valved-conduit and review the published experience with the Valsalva graft.
From Feb 2005 through Sep 2017, 428 patients underwent aortic root replacement utilizing a composite graft constructed from a 27-29-mm Freestyle MS valve (Medtronic) sutured into a 28-30-mm Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, Scotland). Data were retrospectively analyzed.
Mean age was 58±13 years, with a male predominance (337, 79%). Additional surgical procedures included a mitral valve repair/replacement in 10 patients (2%), coronary artery bypass graft (CABG) in 114 patients (27%), and aortic arch (hemi or total) replacement in 252 patients (59%). Average cardiopulmonary bypass, cross-clamp, and circulatory arrest times were 210±57, 180±44, and 29±15 min, respectively. Thirty-day mortality was 7% (31 patients). Mean echocardiography follow-up was 27.2±29.0 months (range, 1-138 months). Pressure gradients (mean, peak) across the aortic valve on latest echocardiography were 5.59, 10.57 mmHg respectively. Freedom from >2+ aortic insufficiency (AI) at 6 and 9 years was 96%, and 87% respectively. Freedom from aortic valve replacement (AVR) at 6 and 9 years was 99%, and 95% respectively. To date, 4 (1%) patients required an additional aortic valve intervention secondary to structural valve degeneration.
Use of the Valsalva graft combined with the Freestyle valve for Bentall procedures is associated with favorable results. Clinical outcomes are excellent and in longitudinal follow-up, valve-related complications are minimal.
生物带瓣管道无需抗凝，且能利用无支架瓣膜出色的血流动力学性能。将主动脉瓣窦纳入新主动脉根部可改善无支架瓣膜的功能及使用寿命。我们报告了使用自制复合带瓣管道进行Bentall手术的经验，并回顾了已发表的有关主动脉瓣窦移植物的经验。
2005年2月至2017年9月，428例患者接受了主动脉根部置换术，使用的复合移植物由一个27 - 29毫米的Freestyle MS瓣膜（美敦力公司）缝合到一个28 - 30毫米的Gelweave主动脉瓣窦假体（苏尔寿血管泰克公司，苏格兰伦弗鲁郡）构建而成。对数据进行回顾性分析。
平均年龄为58±13岁，男性居多（337例，占79%）。其他外科手术包括10例患者（2%）进行二尖瓣修复/置换，114例患者（27%）进行冠状动脉旁路移植术（CABG），252例患者（59%）进行主动脉弓（半弓或全弓）置换。平均体外循环、主动脉阻断和循环停止时间分别为210±57分钟、180±44分钟和29±15分钟。30天死亡率为7%（31例患者）。超声心动图平均随访时间为27.2±29.0个月（范围1 - 138个月）。最新超声心动图检查时主动脉瓣跨瓣压差（平均、峰值）分别为5.59、10.57 mmHg。6年和9年时无中重度主动脉瓣反流（AI）的比例分别为96%和87%。6年和9年时无需主动脉瓣置换（AVR）的比例分别为99%和95%。迄今为止，4例（1%）患者因结构性瓣膜退变需要再次进行主动脉瓣干预。
在Bentall手术中使用主动脉瓣窦移植物联合Freestyle瓣膜可取得良好效果。临床结果出色，在长期随访中，瓣膜相关并发症极少。
