Arnaoutakis George J, Sultan Ibrahim, Siki Mary, Bavaria Joseph E
Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA.
Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Ann Cardiothorac Surg. 2019 May;8(3):302-312. doi: 10.21037/acs.2019.05.08.
Many patients with bicuspid aortic valve (BAV) develop aortic regurgitation but are not considered for valve repair. This is partly due to limited long term data regarding repair durability. The purpose of the review is to summarize the long-term (1 year) outcomes of BAV repair.
A systematic review was performed to evaluate durability and survival following BAV repair. OVID SP versions of MEDLINE and Embase were searched using 'aortic valve', 'bicuspid', 'repair', 'David' 'Yacoub', 'reimplantation' and 'remodeling'.
Initial search produced 770 abstracts, reduced to 92 full papers for review after excluding duplications and abstract review for relevance. Twenty-six studies met full inclusion criteria. BAV repair revealed low operative mortality, with excellent 5-year survival, and low freedom from reoperation. Differences in surgical technique between reimplantation and remodeling do not appear to confer protection against reintervention. Systematic assessment of cusp height and annular stabilization in some form do appear to favor improved long term durability. Leaflet calcification is associated with higher rates of reintervention.
BAV repair is associated with acceptable long term survival. Ongoing standardized outcome assessments will further refine surgical techniques associated with excellent repair durability.
许多二叶式主动脉瓣（BAV）患者会出现主动脉瓣反流，但未被考虑进行瓣膜修复。部分原因是关于修复耐久性的长期数据有限。本综述的目的是总结BAV修复的长期（1年）结果。
进行了一项系统综述，以评估BAV修复后的耐久性和生存率。使用“主动脉瓣”“二叶式”“修复”“大卫”“亚库布”“再植入”和“重塑”等关键词在OVID SP版本的MEDLINE和Embase中进行检索。
初步检索产生了770篇摘要，在排除重复项并根据相关性对摘要进行审查后，减少至92篇全文进行审查。26项研究符合完全纳入标准。BAV修复显示手术死亡率低，5年生存率高，再次手术率低。再植入和重塑之间的手术技术差异似乎并不能防止再次干预。以某种形式对瓣叶高度和瓣环稳定进行系统评估似乎有利于提高长期耐久性。瓣叶钙化与更高的再次干预率相关。
BAV修复与可接受的长期生存率相关。正在进行的标准化结局评估将进一步完善与出色修复耐久性相关的手术技术。
