Yang Bo, Ghita Corina, Makkinejad Alexander, Green China, Wu Xiaoting
Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2024 Apr;167(4):1196-1205.e2. doi: 10.1016/j.jtcvs.2022.07.006. Epub 2022 Jul 16.
To evaluate the safety and efficacy of a novel aortic annular enlargement technique.
From August 2020 to February 2022, 50 consecutive cases of aortic valve replacement with Y-incision aortic annular enlargement and other combined cardiac procedures were performed primarily for severe aortic stenosis. Data were obtained through medical record review, The Society of Thoracic Surgeons database, and National Death Index data.
The median age was 65 (59, 71) years, 70% of patients were female, and 26% had previous cardiac surgery. Sixty-six percent patients had isolated aortic valve replacement. The preoperative mean gradient was 40 (30, 47) mm Hg, and the native aortic annular size was 21 (19, 23) mm. After aortic annular enlargement, the median prosthesis size was 27 (27, 29) with 54% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. 88% of patients received no blood transfusion. There were no major postoperative complications, including operative mortality, renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding, except for 1 stroke. Three-month postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (36, 41) mm without aortic pseudoaneurysm. The postoperative mean gradient was 7 (5, 8) mm Hg and valve area was 1.9 (1.7, 2.3) cm at 3 to 12 months. Mitral and tricuspid valve functions were significantly improved. Survival was 100% at 18 months.
Y-incision aortic annular enlargement was safe and effective for upsizing the aortic annulus by 3 to 4 valve sizes.
评估一种新型主动脉瓣环扩大技术的安全性和有效性。
2020年8月至2022年2月，连续50例因严重主动脉瓣狭窄而接受Y形切口主动脉瓣环扩大术及其他心脏联合手术的主动脉瓣置换病例。数据通过病历回顾、胸外科医师协会数据库和国家死亡指数数据获得。
中位年龄为65（59，71）岁，70%的患者为女性，26%的患者曾接受过心脏手术。66%的患者接受了单纯主动脉瓣置换术。术前平均压差为40（30，47）mmHg，天然主动脉瓣环尺寸为21（19，23）mm。主动脉瓣环扩大后，人工瓣膜的中位尺寸为27（27，29），54%的患者使用尺寸为29或最大尺寸的瓣膜。瓣环扩大的中位增量为3（3，4）个瓣膜尺寸。88%的患者未接受输血。除1例中风外，无重大术后并发症，包括手术死亡率、需要永久性透析的肾衰竭、纵隔炎或因出血而再次手术。术后3个月的计算机断层扫描主动脉造影显示主动脉根部从27（24，30）mm扩大到40（36，41）mm，无主动脉假性动脉瘤。术后3至12个月时，平均压差为7（5，8）mmHg，瓣膜面积为1.9（1.7，2.3）cm²。二尖瓣和三尖瓣功能显著改善。18个月时生存率为100%。
Y形切口主动脉瓣环扩大术在将主动脉瓣环扩大3至4个瓣膜尺寸方面是安全有效的。
