Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Semin Thorac Cardiovasc Surg. 2019;31(4):661-663. doi: 10.1053/j.semtcvs.2019.03.009. Epub 2019 Apr 10.
The short answer to this topic is "No, most incompetent bicuspid aortic valve should not be repaired." Aortic valve repair certainly plays an important role in the management of incompetent bicuspid aortic valve of young patients, and the selection criteria are like those for incompetent tricuspid aortic valve. The tissue that makes the cusps should normal or have minor abnormalities easily corrected by surgery such as plication of the free margin. In addition, the anatomic orientation of the conjoint and the normal cusps should be approximately at 180°. If the root is dilated, reimplantation of the aortic valve is likely the most reproducible approach, and if the root is not dilated but the annulus is, a subannular annuloplasty and correction of the cusp prolapse is adequate. Most patients with incompetent bicuspid aortic valve have malformed, fibrotic and calcified cusps and replacement with either pulmonary autograft or a mechanical aortic valve in young patients and a bioprosthetic aortic valve are likely to provide better long-term outcomes than aortic valve repair.
这个问题的简短答案是“不，大多数功能不全的二叶式主动脉瓣不应修复。”主动脉瓣修复在年轻患者的功能不全二叶式主动脉瓣的治疗中确实起着重要作用，选择标准与功能不全三尖瓣主动脉瓣的选择标准相似。瓣叶组织应正常，或仅有易于通过手术（如游离缘褶叠术）纠正的轻微异常。此外，联合瓣叶和正常瓣叶的解剖方位应大致为 180°。如果根部扩张，主动脉瓣再植入术可能是最可重复的方法，如果根部不扩张但瓣环扩张，则行瓣环下瓣环成形术和纠正瓣叶脱垂即可。大多数功能不全的二叶式主动脉瓣患者的瓣叶都有畸形、纤维化和钙化，在年轻患者中，使用肺动脉自体移植物或机械主动脉瓣置换，以及生物瓣主动脉瓣置换，可能比主动脉瓣修复提供更好的长期结果。
