Shehada Sharaf-Eldin, Benedik Jaroslav, Serrano Maria, Lurbaski Juri, Demircioglu Ender, Wendt Daniel, Jakob Heinz, Mourad Fanar
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany -
Department of Cardiovascular Surgery, Helios Clinic Krefeld, Krefeld, Germany.
J Cardiovasc Surg (Torino). 2019 Apr;60(2):259-267. doi: 10.23736/S0021-9509.18.10690-2. Epub 2018 Nov 20.
Valve sparing root replacement differs in specific points. The main target remains to achieve a perfect intraoperative result and long-term stability. We aimed in this study to present our modified sizing technique for valve-sparing "David" procedure and its mid-term results.
We present a retrospective single-center study. A newly designed sizing ring in addition to triple-armed forceps (Trifeet®) was used to measure the proper size of the Valsalva® prosthesis for patients undergoing David-procedure. Primary endpoints are intraoperative aortic regurgitation (AR) and early postoperative outcomes. Secondary endpoints included freedom from aortic regurgitation or reoperation and overall mortality.
A total of 63 consecutive patients who underwent David procedure between 09/2012 and 12/2016 were evaluated. Mean age was 52±15 years and 76.2% were male. Moderate to severe aortic regurgitation was reported in 60 (95.2%) patients. Four (6.3%) patients presented with type-A aortic dissection, 20 (31.7%) patients had bicuspid and 3 (4.8%) had a unicuspid aortic valve, 2 (3.2%) patients had a prior aortic valve repair. Intraoperative echocardiography revealed no 34 (54%), trace 26 (41.2%) or moderate 3 (4.8%) AR. Stroke, myocardial infarction, and 30-day mortality occurred in 1 patient (1.6%). During follow-up 5 (7.9%) patients needed reoperation due to recurrent AR within a mean of 35±18 months. One could be re-repaired, and the other four underwent aortic valve replacement. A second patient died in the late follow-up.
Our modified sizing technique simplifies the "David-procedure" and allows to achieve a good intraoperative and mid-term results. However, these results have to be confirmed in a larger cohort with a long-term follow-up.
保留瓣膜的根部置换术在具体方面存在差异。主要目标仍然是实现完美的术中效果和长期稳定性。本研究旨在介绍我们改良的保留瓣膜“大卫”手术的尺寸测量技术及其中期结果。
我们进行了一项回顾性单中心研究。除了三臂钳（Trifeet®）外，还使用了一种新设计的尺寸测量环来为接受大卫手术的患者测量Valsalva®人工瓣膜的合适尺寸。主要终点是术中主动脉瓣反流（AR）和术后早期结果。次要终点包括无主动脉瓣反流或再次手术以及总死亡率。
对2012年9月至2016年12月期间连续接受大卫手术的63例患者进行了评估。平均年龄为52±15岁，男性占76.2%。60例（95.2%）患者报告有中重度主动脉瓣反流。4例（6.3%）患者为A型主动脉夹层，20例（31.7%）患者为二叶式主动脉瓣，3例（4.8%）患者为单叶式主动脉瓣，2例（3.2%）患者曾接受过主动脉瓣修复术。术中超声心动图显示无AR的患者有34例（54%），微量AR的患者有26例（41.2%），中度AR的患者有3例（4.8%）。1例患者（1.6%）发生了中风、心肌梗死和30天死亡率。在随访期间，5例（7.9%）患者因复发性AR在平均35±18个月内需要再次手术。1例患者可再次修复，另外4例患者接受了主动脉瓣置换术。1例患者在随访后期死亡。
我们改良的尺寸测量技术简化了“大卫手术”，并能取得良好的术中及中期结果。然而，这些结果必须在更大的队列中进行长期随访来证实。
