Yiğit Görkem, Özen Anıl, Çetinkaya Ferit, Ünal Ertekin Utku, İşcan Hakki Zafer, Birincioğlu Cemal Levent, Sarıtaş Ahmet
Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.
Braz J Cardiovasc Surg. 2021 Apr 1;36(2):192-200. doi: 10.21470/1678-9741-2020-0133.
Valve-reimplantation and remodelling techniques used in aortic reconstruction provide successful early, mid, and long-term results. We present our early and late-term experience with 110 patients with aortic regurgitation (AR) who underwent aortic valve repair (AVr) or valve-sparing aortic root surgeries (VSARS) due to aortic dissection or aortic aneurysm.
Nine hundred eighty-two patients who underwent aneurysm or dissection surgery and aortic valve surgery between April 1997 and January 2017 were analysed using the patient database. A total of 110 patients with AR who underwent AVr or VSARS due to aortic dissection or aortic aneurysm were included in the study.
In the postoperative period, a decrease was observed in AR compared to the preoperative period (P<0.001); there was an increase in postoperative ejection fraction (EF) compared to the preoperative values (P<0.005) and a significant decrease in postoperative left ventricle diameters compared to the preoperative values (P<0.001). Kaplan-Meier analysis revealed one, two, four, and five-year freedom from moderate-severe AR as 95%, 91%, 87%, and 70%, respectively. Freedom from reoperation in one, two, and five years were 97.9%, 93.6%, and 81%, respectively. Eight patients (7.4%) underwent AVr during follow-up. Out of the remaining 100 patients, 13 (12%) had minimum AR, 52 (48%) had 1st-2nd degree AR, and 35 (32%) had 2nd-3rd degree AR during follow-up.
For the purpose of maintaining the native valve tissue, preserving the EF and the left ventricular end-diastolic diameter, valve-sparing surgeries should be preferred for appropriate patients.
主动脉重建中使用的瓣膜再植入和重塑技术在早期、中期和长期均取得了成功的效果。我们介绍了110例主动脉瓣反流(AR)患者的早期和晚期经验,这些患者因主动脉夹层或主动脉瘤接受了主动脉瓣修复(AVr)或保留瓣膜的主动脉根部手术(VSARS)。
利用患者数据库对1997年4月至2017年1月期间接受动脉瘤或夹层手术及主动脉瓣手术的982例患者进行分析。本研究共纳入110例因主动脉夹层或主动脉瘤接受AVr或VSARS的AR患者。
术后与术前相比,AR有所下降(P<0.001);术后射血分数(EF)较术前值有所增加(P<0.005),术后左心室直径较术前值显著减小(P<0.001)。Kaplan-Meier分析显示,中度至重度AR的1年、2年、4年和5年无事件生存率分别为95%、91%、87%和70%。1年、2年和5年的再次手术无事件生存率分别为97.9%、93.6%和81%。8例患者(7.4%)在随访期间接受了AVr。在其余100例患者中,13例(12%)在随访期间有最小程度的AR,52例(48%)有1-2级AR,35例(32%)有2-3级AR。
为了保留天然瓣膜组织、维持EF和左心室舒张末期直径,对于合适的患者应首选保留瓣膜的手术。