Weltert Luca, Licitra Rosaria, Salica Andrea, Irace Francesco, De Paulis Ruggero
European Hospital Heart Surgery Department, Professor of Biostatistics Saint Camillus International University of Health and Medical Sciences (UniCamillus), Rome, Italy.
Ospedale Sant'Eugenio - U.O. Cardiologia, Rome, Italy.
Surg Technol Int. 2019 Nov 10;35:217-232.
This is the third and final part of our update on the latest advances in cardiac valvular replacement. Part 1 was dedicated to cardiac valvular replacement, and Part 2 focused on transcatheter cardiac valvular treatment. This part concerns annuloplasty prostheses for valvular reconstructive surgery. The number of patients undergoing surgical heart valve repair has been increasing, particularly in high-volume centers. Annuloplasty is now considered the gold standard in mitral valve regurgitation repair secondary to degenerative, ischemic and idiopathic dilated cardiomyopathy disease. The techniques of mitral valve reconstruction have been well established, but controversies remain regarding the type of annuloplasty ring to be used. The available annuloplasty rings include rigid, flexible, complete, partial, and semi-rigid/flexible. The choice of annuloplasty ring has been the focus of extensive investigation and debate, but to date it still largely remains a matter of "surgeon's preference" rather than an evidence-based selection. Functional tricuspid regurgitation was traditionally treated by the classic De Vega annuloplasty, but has since evolved after the development of prosthetic tricuspid annuloplasty. Head-to-head comparisons have demonstrated superior long-term outcomes with device-based annuloplasty compared to suture-based surgery, but the type of ring to be used (flexible versus rigid) has recently been questioned, without reaching definitive conclusions. In contrast to mitral and tricuspid valve repair, aortic repair is more difficult with respect to specific valve features. Annuloplasty is considered to play a key role in controlling aortic regurgitation and preventing recurrence after valve repair. Various modifications of annuloplasty have been advocated (internal/external, with/without ring (suture), rigid/flexible ring). but none of them has become a de facto standard. This paper describes the various rings that are available to help orient surgeons and to serve as a reference for students.
这是我们关于心脏瓣膜置换最新进展系列更新的第三部分，也是最后一部分。第一部分专注于心脏瓣膜置换，第二部分聚焦经导管心脏瓣膜治疗。本部分涉及瓣膜重建手术中的瓣环成形假体。接受心脏瓣膜修复手术的患者数量一直在增加，尤其是在大型医疗中心。瓣环成形术目前被认为是治疗因退行性病变、缺血性和特发性扩张型心肌病导致的二尖瓣反流修复的金标准。二尖瓣重建技术已经成熟，但在使用何种瓣环成形环方面仍存在争议。现有的瓣环成形环包括刚性、柔性、完整、部分以及半刚性/柔性环。瓣环成形环的选择一直是广泛研究和争论的焦点，但迄今为止，这在很大程度上仍然是“外科医生的偏好”问题，而非基于证据的选择。传统上，功能性三尖瓣反流通过经典的德维加瓣环成形术治疗，但自人工三尖瓣瓣环成形术发展以来，情况有所演变。直接对比显示，与基于缝线的手术相比，基于器械的瓣环成形术具有更优的长期疗效，但最近关于使用何种环（柔性与刚性）的问题受到质疑，尚未得出明确结论。与二尖瓣和三尖瓣修复不同，由于主动脉瓣的特定结构特点，主动脉瓣修复更为困难。瓣环成形术被认为在控制主动脉瓣反流和预防瓣膜修复后复发方面起关键作用。人们提倡对瓣环成形术进行各种改良（内部/外部、有/无环（缝线）、刚性/柔性环），但它们都未成为事实上的标准。本文介绍了各种可用的瓣环，以帮助指导外科医生，并为学生提供参考。
