Hori Daijiro, Yamaguchi Atsushi
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Kyobu Geka. 2021 Sep;74(10):740-745.
With increasing number of patients undergoing aortic valve replacement, many patients are at risk for redo aortic valve surgery. It has been reported that 56.2% of the patients receiving a bioprostheis and 7.4% of the patients receiving a mechanical valve need reoperation 20 years after the primary surgery. Although valve in valve transcatheter aortic valve implantation (TAVI) is a less invasive approach, redo aortic valve replacement is preferred for patients with prosthetic valve endocarditis, small aortic valve prosthesis and poor access for TAVI. Special care should be prepared for safe re-sternotomy, cardiopulmonary bypass management and strategy for cardioplegia. As reported from high volume centers, redo aortic valve replacement could be performed at a similar mortality rate as the primary surgery. New prostheses such as sutureless valve and rapid deployment valve could be useful, as well as minimally invasive cardiac surgery approach, which may prevent tissue injury. However, redo aortic valve replacement via re-sternotomy remains a gold standard. Techniques and strategy for redo aortic valve replacement are reviewed.
随着接受主动脉瓣置换术的患者数量不断增加，许多患者面临再次进行主动脉瓣手术的风险。据报道，接受生物瓣膜置换的患者中有56.2%以及接受机械瓣膜置换的患者中有7.4%在初次手术后20年需要再次手术。尽管经导管主动脉瓣植入术（TAVI）中的瓣中瓣技术是一种侵入性较小的方法，但对于人工瓣膜心内膜炎、主动脉瓣假体较小以及TAVI入路不佳的患者，再次主动脉瓣置换术仍是首选。对于安全的再次胸骨切开术、体外循环管理和心脏停搏策略应做好特殊准备。据大容量中心报道，再次主动脉瓣置换术的死亡率与初次手术相似。新型假体如无缝合瓣膜和快速部署瓣膜可能会有用，微创心脏手术方法也可能会有用，这可能会防止组织损伤。然而，经再次胸骨切开术进行再次主动脉瓣置换术仍然是金标准。本文对再次主动脉瓣置换术的技术和策略进行了综述。
