49550 Department of Cardiac Surgery, Wroclaw Medical University, Poland.
5631 Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA.
Innovations (Phila). 2021 May-Jun;16(3):267-272. doi: 10.1177/1556984521997422. Epub 2021 Mar 18.
In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr.
Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction. Fifty-four (73%) had ascending aortic ( = 25) and/or root ( = 29) aneurysms, and aortic grafts were sized 5 to 7 mm larger than the rings. Intraoperatively, leaflet free-edge length (FEL) was measured with special ball sizers positioned in the coronary sinus, and "normal" annular diameter was predicted from the validated formula: Required "normal" diameter = FEL/1.5. "Normal" annular diameters predicted from FEL were compared with pathologic diameters measured intraoperatively with Hegar dilators, and both were correlated with gender, age, and BSA.
Average age was 62.1 ± 13.3 years (mean ± SD), 73% (54/74) were male, and 96% (71/74) had moderate-to-severe AI. All patients had annular dilatation, with a pathologic diameter 26.6 ± 2.3 mm before repair, and a predicted "normal" diameter of 21.7 ± 1.7 mm ( < 0.001). Both predicted and pathologic annular diameters were larger in men ( < 0.001), but no relationship existed with age. BSA correlated with both predicted and pathologic diameters, although variability was large.
Based on a simple validated method to predict "normal" annular diameter, all patients with chronic AI have some degree of annular dilatation. This finding implies that most AVr should include annuloplasty, with adequate and precise annular reduction based on leaflet size.
在慢性主动脉瓣关闭不全（AI）中，主动脉瓣修复（AVr）中实现持久对合所需的环缩程度和方法仍未得到明确界定。本研究评估了瓣叶大小与瓣环直径之间的关系，以预测在重塑 AVr 中进行适当的瓣环缩径。
在监管监督下，74 例慢性三叶瓣 AI 患者接受了使用环形瓣环成形术和瓣叶重建的 AVr。54 例（73%）患者有升主动脉（=25 例）和/或根部（=29 例）动脉瘤，主动脉移植物比环大 5 至 7 毫米。术中使用特殊的球型扩张器在冠状窦中测量瓣叶游离缘长度（FEL），并使用验证过的公式预测“正常”瓣环直径：所需“正常”直径=FEL/1.5。将从 FEL 预测的“正常”瓣环直径与术中用 Hegar 扩张器测量的病理直径进行比较，并与性别、年龄和 BSA 进行相关性分析。
平均年龄为 62.1±13.3 岁（均值±标准差），73%（54/74）为男性，96%（71/74）为中重度 AI。所有患者均有瓣环扩张，修复前的病理瓣环直径为 26.6±2.3mm，预测的“正常”瓣环直径为 21.7±1.7mm（<0.001）。预测的和病理的瓣环直径在男性中均较大（<0.001），但与年龄无关。BSA 与预测的和病理的瓣环直径均相关，但变异性较大。
基于一种简单的预测“正常”瓣环直径的验证方法，所有慢性 AI 患者均有一定程度的瓣环扩张。这一发现表明，大多数 AVr 应包括瓣环成形术，并根据瓣叶大小进行适当和精确的瓣环缩小。
