Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri.
Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri.
Ann Thorac Surg. 2020 Jun;109(6):1820-1825. doi: 10.1016/j.athoracsur.2019.09.038. Epub 2019 Nov 4.
Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement. This study examined the outcomes of a technique for left ventricular outflow tract reconstruction using a polyester tube graft, followed by translocation of the aortic valve and coronary arteries.
A total of 23 patients with extensive annular erosion resulting from endocarditis or previous aortic valve replacement with or without pseudoaneurysm formation, or occurring after excision of the native valve, underwent suture of a polyester tube graft in the left ventricular outflow tract below the annulus, replacement of the aortic valve and proximal ascending aorta with a composite graft, and reimplantation of the coronary arteries with the use of interposition polyester grafts. The mean age of the patients was 50 years, and 57% were men.
There were no hospital deaths. The mean duration of follow-up was 6.5 years and extended to 16 years. Actuarial survival at 1, 5, and 10 years was 86.7%, 82.2%, and 62.6%, respectively. Two patients required reoperation for a graft-graft pseudoaneurysm and for degeneration of a porcine bioprosthesis. Echocardiograms obtained at a mean of 75 months postoperatively in 15 of the 23 patients demonstrated normal left ventricular outflow tract dimensions and velocities and a mean effective valve orifice area of 1.07 cm/m. All coronary artery grafts were patent on angiography a mean of 40 months postoperatively in 13 patients.
Extended experience with this technique confirms its safety and effectiveness for patients with extensive destruction of the aortic annulus. It represents a suitable alternative to other currently used techniques.
主动脉瓣环侵蚀是主动脉瓣心内膜炎或既往主动脉瓣置换术的严重并发症。本研究探讨了使用聚酯管移植物重建左心室流出道，然后转位主动脉瓣和冠状动脉的技术的结果。
共有 23 例因心内膜炎或既往主动脉瓣置换术导致广泛瓣环侵蚀的患者，伴或不伴假性动脉瘤形成，或在切除原生瓣后发生瓣环侵蚀，接受聚酯管移植物在瓣环下方左心室流出道的缝合，使用复合移植物置换主动脉瓣和近端升主动脉，并使用间隔聚酯移植物重新植入冠状动脉。患者的平均年龄为 50 岁，57%为男性。
无院内死亡。平均随访时间为 6.5 年，最长随访时间为 16 年。1、5、10 年的累积生存率分别为 86.7%、82.2%和 62.6%。2 例患者因移植物-移植物假性动脉瘤和猪生物瓣退行性变需要再次手术。23 例患者中的 15 例在术后平均 75 个月进行的超声心动图检查显示正常的左心室流出道尺寸和速度，平均有效瓣口面积为 1.07cm/m。13 例患者术后平均 40 个月的冠状动脉造影显示所有冠状动脉移植物通畅。
该技术的扩展经验证实了其对广泛破坏主动脉瓣环的患者的安全性和有效性。它代表了目前使用的其他技术的一种合适替代方案。
