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诊断为主动脉瘤或主动脉夹层合并主动脉反流的患者接受主动脉瓣修复或保留瓣膜主动脉手术的早期和晚期随访结果

Early and Late-Term Follow-Up Results of Patients Diagnosed with Aortic Aneurysm or Aortic Dissection with Aortic Regurgitation Undergoing Aortic Valve Repair or Valve-Sparing Aortic Surgery.

作者信息

Yiğit Görkem, Özen Anıl, Çetinkaya Ferit, Ünal Ertekin Utku, İşcan Hakki Zafer, Birincioğlu Cemal Levent, Sarıtaş Ahmet

机构信息

Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey.

出版信息

Braz J Cardiovasc Surg. 2021 Apr 1;36(2):192-200. doi: 10.21470/1678-9741-2020-0133.

Abstract

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

摘要

引言

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)。

方法

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。

结果

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。

结论

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6c6e/8163274/e9829517ece4/rbccv-36-02-0192-g01.jpg

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