Massias Samuel A, Pittams Ashleigh, Mohamed Malak, Ahmed Shajada, Younas Hiba, Harky Amer
St George's School of Medicine, University of London, London, UK.
Royal Sussex County Hospital, Brighton, UK.
J Card Surg. 2021 Jan;36(1):229-235. doi: 10.1111/jocs.15175. Epub 2020 Oct 30.
Aortic valve replacement is the definitive management for severe aortic stenosis. Intraoperatively, an aortic root enlargement (ARE) may be used to facilitate the implementation of a suitably sized prosthetic valve. This is to prevent patient prosthesis mismatch (PPM), a condition that causes a left ventricular outflow obstruction. There are four main techniques that are used to perform ARE, namely, Nicks, Manouguian, Nunez (modified Manouguian), and Kanno-Rastan procedures. They each involve incisions through different anatomical structures and allow a variety of valve sizes to be implanted. Studies prove that ARE effectively reduces the incidence of PPM. In addition, they show that there is no definitive link between ARE and perioperative mortality or other complications. There is a scarcity of literature exploring the comparative outcomes of each surgical technique. Therefore, further research is warranted for these procedures to be compared adequately. This review aims to summarise the available literature surrounding ARE with respect to three main questions. (1) What are the indications for ARE, (2) what surgical techniques exist to facilitate ARE, and (3) are there significant differences in patient outcomes when these surgical techniques are employed?
主动脉瓣置换术是重度主动脉瓣狭窄的确定性治疗方法。术中，可采用主动脉根部扩大术（ARE）来便于植入尺寸合适的人工瓣膜。这是为了防止患者-人工瓣膜不匹配（PPM），这种情况会导致左心室流出道梗阻。有四种主要技术用于实施ARE，即尼克斯（Nicks）法、马努吉安（Manouguian）法、努涅斯（Nunez，改良马努吉安法）法和卡诺-拉斯坦（Kanno-Rastan）法。它们各自涉及通过不同解剖结构的切口，并允许植入多种瓣膜尺寸。研究证明，ARE能有效降低PPM的发生率。此外，研究表明ARE与围手术期死亡率或其他并发症之间没有明确的关联。探索每种手术技术比较结果的文献较少。因此，有必要进行进一步研究以充分比较这些手术方法。本综述旨在围绕ARE总结现有文献，涉及三个主要问题。（1）ARE的适应证是什么，（2）有哪些便于实施ARE的手术技术，（3）采用这些手术技术时患者的结局是否存在显著差异？
