Yanagawa Bobby, Mazine Amine, El-Hamamsy Ismail
1 Divisions of Cardiac Surgery, St Michael's Hospital, University of Toronto, Canada.
2 Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada.
Innovations (Phila). 2019 Jun;14(3):199-208. doi: 10.1177/1556984519845905. Epub 2019 May 14.
Aortic valve repair is the preferred approach for the treatment of severe aortic insufficiency (AI), as it allows patients to keep their native aortic valve, thus substantially reducing the risk of prosthesis-related complications. Several studies have documented excellent long-term outcomes of aortic valve repair. The major complication of this operation is AI recurrence, with ensuingneed for reoperation. The surgical experience accumulated over the last two decades has allowed for better understanding of the mechanisms of recurrent AI after aortic valve repair. Herein, we review the current state of knowledge on predictors of aortic valve repair failure. These include unaddressed annular dilation, residual cusp prolapse or retraction, commissural orientation, and use of patch material. This enhanced understanding has led to the development of increasingly refined techniques and improved patient outcomes. Continued follow-up and detailed data collection at the time of surgery, together with three-dimensional echo imaging, will allow further improvements in aortic valve repair.
主动脉瓣修复是治疗重度主动脉瓣关闭不全（AI）的首选方法，因为它能让患者保留自身的主动脉瓣，从而大幅降低与人工瓣膜相关的并发症风险。多项研究已证明主动脉瓣修复具有出色的长期疗效。该手术的主要并发症是AI复发，继而需要再次手术。过去二十年积累的手术经验使人们对主动脉瓣修复术后AI复发的机制有了更好的理解。在此，我们综述了目前关于主动脉瓣修复失败预测因素的知识现状。这些因素包括未解决的瓣环扩张、残留的瓣叶脱垂或回缩、瓣叶连合处的方向以及补片材料的使用。这种深入的理解促使了技术的不断完善和患者预后的改善。持续的随访以及手术时详细的数据收集，再加上三维超声成像，将进一步改进主动脉瓣修复。
