Youssefi Pouya, Lansac Emmanuel
Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France.
Indian J Thorac Cardiovasc Surg. 2020 Jan;36(Suppl 1):88-96. doi: 10.1007/s12055-019-00852-9. Epub 2019 Oct 7.
Dystrophic aortic insufficiency accounts for the majority of Western cases of aortic insufficiency and can be divided into the three phenotypes of isolated aortic insufficiency, dilated aortic root, and dilated ascending aorta. Each of these phenotypes is associated with a dilated annulus and/or sinotubular junction. Recent international guidelines recommend reimplantation or remodeling with aortic annuloplasty for valve-sparing root replacement, as well as consideration of aortic valve repair in cases of aortic insufficiency. A dilated aortic annulus is a major risk factor for failure of aortic valve repair procedures, indicating the need to address the annulus at the time of aortic valve or root repair. Calibrated annuloplasty should be performed at sub- and supravalular levels in order to restore the ratio of the sinotubular junction and annulus and be adapted according to the phenotype of the root and ascending aorta. Standardization of aortic valve repair techniques with use of a calibrated annuloplasty will improve dissemination of techniques and rate of aortic valve repair. Current medical evidence shows that aortic valve repair is safe, produces better quality of life, and reduces valve-related mortality compared to prosthetic valve replacement.
营养不良性主动脉瓣关闭不全占西方主动脉瓣关闭不全病例的大多数，可分为单纯主动脉瓣关闭不全、主动脉根部扩张和升主动脉扩张三种表型。这些表型中的每一种都与瓣环和/或窦管交界处扩张有关。最近的国际指南建议，对于保留瓣膜的根部置换术，采用主动脉瓣环成形术进行再植入或重塑，对于主动脉瓣关闭不全的病例，也应考虑进行主动脉瓣修复。扩张的主动脉瓣环是主动脉瓣修复手术失败的主要危险因素，这表明在主动脉瓣或根部修复时需要处理瓣环。应在瓣下和瓣上水平进行校准瓣环成形术，以恢复窦管交界处与瓣环的比例，并根据根部和升主动脉的表型进行调整。使用校准瓣环成形术使主动脉瓣修复技术标准化，将改善技术的传播和主动脉瓣修复率。目前的医学证据表明，与人工瓣膜置换相比，主动脉瓣修复是安全的，能产生更好的生活质量，并降低瓣膜相关死亡率。
