Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Department of Cardiac Surgery and Cardiosurgical Intensive Care, Children's University Hospital, Jagiellonian University Medical College, Krakow, Poland.
Eur J Cardiothorac Surg. 2021 Apr 29;59(4):758-764. doi: 10.1093/ejcts/ezaa414.
The study objective was to describe the technique and outcomes of original coronary ostial slide plasty in patients with anomalous coronary artery origin (ACAO) localized in the aneurysmal ascending aorta (AA) being replaced because of its isolated pathology and otherwise non-pathological aortic root.
A total of 23 patients (median age 52 years) with the ascending phenotype of proximal aorta aneurysm and ACAO of at least 1 coronary artery localized in the AA being replaced underwent ostial slide plasty to transpose the ACAO to the respective sinus of Valsalva and, consequently, to allow an AA replacement with placement of the proximal anastomosis at the level of the sinotubular junction (STJ). In 15 patients, the aortic valve was bicuspid, and all but 3 patients presented with a relevant valve defect. In addition to remodelling the STJs (all patients), valve-sparing repair or replacement was performed in 12 and 8 patients, respectively.
No patient died during the entire follow-up (median 72, range 3-183 months). One patient required replacement of a recurrently insufficient valve that was repaired primarily using cusp patch plasty, but there were no further cardiac reoperations nor any re-interventions on the proximal aorta, aortic valve and/or coronary artery ostia. Two patients received peripheral coronary stents (8 and 7 years after surgery, respectively) due to coronary heart disease.
Transposition of the ACAO from the replaced AA into the normal sinus of Valsalva using the ostial slide plasty offers a simple and safe surgical option enabling a recreation of a durable STJ at the level of the anastomosis between the root and the aortic graft.
本研究旨在描述对因孤立性病变而接受置换的升主动脉瘤患者进行冠状动脉起源异常（ACAO）的原发冠状动脉口滑动成形术的技术和结果，这些患者的升主动脉根部具有其他非病理性病变。
共有 23 名患者（中位年龄 52 岁）具有近端升主动脉瘤的升主动脉表型和至少 1 支位于升主动脉的 ACAO，这些患者接受了冠状动脉口滑动成形术，将 ACAO 转移到相应的主动脉窦，并由此允许在窦管交界（STJ）水平进行升主动脉置换，以吻合近端吻合口。在 15 名患者中，主动脉瓣为二叶瓣，除 3 名患者外，所有患者均存在相关瓣叶缺陷。除了重塑 STJ（所有患者）外，分别对 12 名和 8 名患者进行了保留瓣叶的修复或置换。
在整个随访期间（中位随访时间 72 个月，范围 3-183 个月），没有患者死亡。1 名患者需要更换再次出现功能不全的瓣膜，该瓣膜最初采用瓣叶补片修复，但没有进行其他心脏再次手术，也没有对近端升主动脉、主动脉瓣和/或冠状动脉口进行进一步干预。2 名患者因冠心病分别在术后 8 年和 7 年接受了外周冠状动脉支架置入术。
使用冠状动脉口滑动成形术将替换的升主动脉中的 ACAO 转移到正常的主动脉窦中，是一种简单而安全的手术选择，可在根部和主动脉移植物之间的吻合处重建持久的 STJ。
