Department of Cardiac Surgery, University Hospital in Wroclaw, 50-556, Wrocław, Poland.
Department of Cardiac Surgery, Children's Memorial Paediatric Health Institute, Warsaw, Poland.
BMC Cardiovasc Disord. 2021 Jan 6;21(1):13. doi: 10.1186/s12872-020-01831-4.
The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodelling using cardiac magnetic resonance (CMR) and compare the results of external and subcommissural annuloplasty.
Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA).
11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period (median: 12.6 months (first quartile: 6.6; third quartile: 14.1). CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r = 0.62; p = 0.003) as well as left ventricular ejection fraction (r = -0.53; p = 0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5 (2.5; 4.0) vs. 2.5 cm (2.0; 3.4); p = 0.04). In both EA and SCA group, aortic valve area below 3.5 cm correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10 (6; 17) vs. 21 mmHg (15; 27); p = 0.04).
The repair of the bicuspid aortic valve provides significant postoperative reverse remodelling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. EA is associated with lower transvalvular gradients and higher aortic valve area assessed by CMR, compared to SCA.
功能不全的二叶式主动脉瓣（BAV）可使用各种外科技术进行置换或修复。本研究旨在评估心脏磁共振（CMR）检查中外环成形术和术后反向重构的效果，并比较外环和瓣下成形术的结果。
在 2004 年至 2018 年间进行的 200 例 BAV 修复手术中，连续选择 21 例因反流而需要瓣环成形术修复的患者（中位年龄 54 岁），在手术后 1 年进行 CMR 和经胸超声心动图（TTE）检查。使用两种主动脉瓣环稳定技术：外环成形术（EA）和瓣下成形术（SCA）。
11 例患者接受 EA 治疗，10 例患者接受 SCA 治疗。无院内死亡，所有患者均存活至随访期末（中位时间：12.6 个月（第一四分位数：6.6；第三四分位数：14.1）。CMR 显示术后主动脉瓣再次反流分数与左心室舒张末期容积（r=0.62；p=0.003）和左心室射血分数（r=-0.53；p=0.01）之间存在强相关性。与 SCA 相比，接受 EA 治疗的患者 CMR 测量的解剖学主动脉瓣面积更大（3.5（2.5；4.0）cm² vs. 2.5（2.0；3.4）cm²；p=0.04）。在 EA 和 SCA 组中，主动脉瓣面积<3.5cm²与无反流复发相关。与 SCA 相比，EA（vs. SCA）与较低的跨瓣主动脉峰压差相关（10（6；17）mmHg vs. 21mmHg（15；27）；p=0.04）。
二叶式主动脉瓣修复术后可显著实现反向重构，只要没有发生再次反流且瓣环成形术能够持久地缩小瓣环。与 SCA 相比，EA 与较低的跨瓣主动脉梯度和 CMR 评估的较高的主动脉瓣面积相关。
