Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Asian Cardiovasc Thorac Ann. 2021 Jun;29(5):381-387. doi: 10.1177/0218492320977981. Epub 2020 Nov 29.
Aortic root reoperation after aortic dissection repair sometimes requires aortic root replacement. A valve-preserving technique should be applied when the aortic cusp is normal. Valve-sparing aortic root reconstruction using the reimplantation technique resolves aortic valve regurgitation, root dilatation, and pseudoaneurysm in the proximal anastomosis. Our experience in aortic root reoperation is presented.
From January 2000 to March 2019, 26 patients underwent reoperative valve-sparing aortic root reconstruction using the reimplantation technique. The time from the initial operation to reoperation was 69.3 ± 51.6 months. Aortic root reoperation was required for a fragile wall at the previous proximal anastomosis or aortic root dilatation. We aimed to stabilize the aortic root without valve regurgitation. The native aortic cusp was aggressively preserved when nearly normal. Indications included root dilatation ( = 13), pseudoaneurysm of the previous proximal anastomosis ( = 11), and aortic valve regurgitation ( = 4).
There was no early postoperative mortality. Follow-up was 49 ± 47 months (range 4-161 months). The 3, 5, and 10-year survival was 88.9% ± 7.4%, 88.9% ± 7.4%, and 77.8% ± 12.2%, respectively. Freedom from recurrence of a greater than moderate degree of aortic valve regurgitation at 3, 5, and 10 years was 86.5% ± 8.9%, 86.5% ± 8.9%, and 86.5% ± 8.9%, respectively. One patient underwent aortic valve replacement for recurrent aortic valve regurgitation 15 months after the valve-sparing reoperation.
Midterm outcomes of reoperative valve-sparing aortic root reconstruction using the reimplantation technique and postoperative aortic valve performance were satisfactory.
主动脉夹层修复后的主动脉根部再次手术有时需要进行主动脉根部置换。当主动脉瓣叶正常时，应采用保留瓣膜技术。采用再植入技术的保留瓣膜主动脉根部重建术可解决主动脉瓣关闭不全、根部扩张和近端吻合口假性动脉瘤。本文介绍了我们的主动脉根部再次手术经验。
自 2000 年 1 月至 2019 年 3 月，26 例患者接受了再植入技术的再次保留瓣膜主动脉根部重建术。初次手术至再次手术的时间为 69.3±51.6 个月。再次手术的原因是前次近端吻合口的脆弱壁或主动脉根部扩张。我们的目标是在没有瓣叶关闭不全的情况下稳定主动脉根部。当主动脉瓣叶几乎正常时，积极保留原生瓣叶。适应证包括根部扩张（n=13）、前次近端吻合口假性动脉瘤（n=11）和主动脉瓣关闭不全（n=4）。
无术后早期死亡。随访时间为 49±47 个月（4-161 个月）。3、5 和 10 年生存率分别为 88.9%±7.4%、88.9%±7.4%和 77.8%±12.2%。3、5 和 10 年时无中度以上主动脉瓣关闭不全复发的生存率分别为 86.5%±8.9%、86.5%±8.9%和 86.5%±8.9%。1 例患者在保留瓣膜再手术后 15 个月因主动脉瓣关闭不全复发行主动脉瓣置换术。
采用再植入技术的再次保留瓣膜主动脉根部重建术的中期结果和术后主动脉瓣功能令人满意。
