De Paulis Ruggero, Scaffa Raffaele
Department of Cardiac Surgery, European Hospital, Via Portuense 70, 00149 Rome, Italy.
Indian J Thorac Cardiovasc Surg. 2019 Jun;35(Suppl 2):92-95. doi: 10.1007/s12055-018-0655-x. Epub 2018 Mar 5.
The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing otherwise normal aortic valves in the presence of a root aneurysm. Important achievements in this discipline have occurred over the past decade including development and refinement of valve preserving aortic root replacement techniques, development of a classification system for aortic insufficiency, and development of surgical approaches to cusp disease with varying cusp anatomy. The main advantage of the reimplantation is the resulting annular support, and the disadvantages are the unfavorable hemodynamics and relatively longer procedural time. Conversely, the main advantages of remodeling are the physiological hemodynamics and the shorter procedural time, and the disadvantage is the lack of annular support. With technical advances and modifications, however, the differences between these two procedures have narrowed. Today preference for a reimplantation procedure is based on the perception of a better reproducibility of the surgical procedure, an increased procedural safety due to the characteristic hemostatic feature of this surgical approach, the possibility of achieving favorable hemodynamics, and a much larger amount of data present in the literature on long-term results.
25年多前就已描述了重塑和再植入手术，目的是在存在根部动脉瘤的情况下保留原本正常的主动脉瓣。在过去十年中，该领域取得了重要进展，包括保留瓣膜的主动脉根部置换技术的发展和完善、主动脉瓣关闭不全分类系统的开发以及针对不同瓣叶解剖结构的瓣叶疾病手术方法的开发。再植入的主要优点是产生的瓣环支撑，缺点是血流动力学不佳和手术时间相对较长。相反，重塑的主要优点是生理血流动力学和较短的手术时间，缺点是缺乏瓣环支撑。然而，随着技术的进步和改进，这两种手术之间的差异已经缩小。如今，对再植入手术的偏好基于这样一种认识，即该手术具有更好的可重复性、由于这种手术方法的特征性止血特性而提高的手术安全性、实现良好血流动力学的可能性以及文献中关于长期结果的大量数据。
