Cui Huimin, Zhang Lin, Wei Shixiong, Jiang Shengli
Department of Cardiovascular Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
J Cardiothorac Surg. 2019 Nov 27;14(1):203. doi: 10.1186/s13019-019-1022-8.
This study aimed to confirm the safety and feasibility of simple pannus removal in patients with mechanical aortic valve dysfunction for pannus overgrowth by evaluating its early clinical outcomes.
From March 2015 to April 2019, 24 consecutive patients with mechanical aortic valve dysfunction due to subaortic pannus underwent reoperation. In 12 patients the repeat aortic valve replacement (AVR) was performed, and 12 received the simple pannus removal to preserve the previously implanted prosthesis.
There was only 1 in-hospital death in simple pannus removal group. Significant differences were obtained between procedures in cardiopulmonary bypass (CPB) and aortic cross-clamp time (128.7 vs 179.7 and 74.2 vs 132.7 mins, respectively, P < 0.05). The C-reactive protein (CRP) in simple pannus removal group was lower on the first day (0.13 ± 0.09 vs 0.31 ± 0.22 mg/dl, P < 0.05) and continued to be lower within 1 week after operation. There was no significant difference between procedures in aortic transvalvular peak velocity and transvalvular mean pressure gradient (TMPG) (2.6 ± 0.4 vs 2.5 ± 0.4 m/s and 13.2 ± 3.6 vs 11.6 ± 2.6 mmHg, respectively, P > 0.05) in echocardiography 1 week after operation. In addition, the aortic transvalvular peak velocity and TMPG in echocardiography 1 week after operation in pannus removal group between the repeat and initial surgery were not statistically significant (2.6 ± 0.4 vs. 2.5 ± 0.3 m/s, 13.2 ± 3.6 vs. 13.0 ± 3.5 mmHg, P > 0.05).
Simple pannus removal was a safe and effective procedure with satisfied early clinical outcomes for pannus overgrowth in mechanical aortic valve. However, further randomized and long-term follow-up studies were warranted to determine the clinical effects of the simple aortic pannus removal.
本研究旨在通过评估早期临床结果，确认单纯切除机械主动脉瓣功能障碍患者因血管翳过度生长所致血管翳的安全性和可行性。
2015年3月至2019年4月，连续24例因主动脉瓣下血管翳导致机械主动脉瓣功能障碍的患者接受再次手术。12例患者进行了再次主动脉瓣置换术（AVR），12例接受单纯血管翳切除术以保留先前植入的人工瓣膜。
单纯血管翳切除组仅1例住院死亡。两组在体外循环（CPB）时间和主动脉阻断时间方面存在显著差异（分别为128.7对179.7分钟和74.2对132.7分钟，P<0.05）。单纯血管翳切除组术后第1天的C反应蛋白（CRP）较低（0.13±0.09对0.31±0.22mg/dl，P<0.05），且术后1周内持续较低。术后1周超声心动图检查显示，两组在主动脉跨瓣峰值流速和跨瓣平均压力阶差（TMPG）方面无显著差异（分别为2.6±0.4对2.5±0.4m/s和13.2±3.6对11.6±2.6mmHg，P>0.05）。此外，血管翳切除组术后1周超声心动图检查的再次手术与初次手术相比，主动脉跨瓣峰值流速和TMPG无统计学意义（2.6±0.4对2.5±0.3m/s，13.2±3.6对13.0±3.5mmHg，P>0.05）。
单纯血管翳切除术是一种安全有效的手术，对于机械主动脉瓣血管翳过度生长具有满意的早期临床结果。然而，需要进一步的随机和长期随访研究来确定单纯主动脉血管翳切除术的临床效果。
