Myers John L, Clark J Brian, James Timothy W, Downs Emily, Hasan Saad M, Binford Robert S, McNeil Jeffrey D, Rodriquez Victor M, Mascio Christopher E, Wei Lawrence M, Badhwar Vinay, Rankin J Scott
Pennsylvania State University, Hershey, Pa.
St Joseph's Hospital, Tacoma, Wash.
JTCVS Tech. 2023 Apr 6;19:30-37. doi: 10.1016/j.xjtc.2023.02.017. eCollection 2023 Jun.
Aortic valve repair can be limited by inadequate leaflet tissue for proper coaptation. Various kinds of pericardium have been used for cusp augmentation, but most have failed because of tissue degeneration. A more durable leaflet substitute is needed.
In this report, 8 consecutive cases are presented in which autologous ascending aortic tissue was used to augment inadequate native cusps during aortic valve repair. Biologically, aortic wall is a living autologous tissue that could have exceptional durability as a leaflet substitute. Techniques for insertion are described in detail, along with procedural videos.
Early surgical outcomes were excellent, with no operative mortalities or complications, and all valves were competent with low valve gradients. Patient follow-up and echocardiograms to a maximum of 8 months' postrepair remain excellent.
Because of superior biologic characteristics, aortic wall has the potential to provide a better leaflet substitute during aortic valve repair and to expand patient categories amenable to autologous reconstruction. More experience and follow-up should be generated.
主动脉瓣修复可能因瓣叶组织不足无法实现恰当对合而受到限制。多种心包已被用于瓣叶增厚，但大多数因组织退变而失败。需要一种更持久的瓣叶替代物。
在本报告中，呈现了连续8例在主动脉瓣修复期间使用自体升主动脉组织增厚不足的天然瓣叶的病例。从生物学角度看，主动脉壁是一种有生命的自体组织，作为瓣叶替代物可能具有卓越的耐久性。详细描述了植入技术以及手术视频。
早期手术结果极佳，无手术死亡或并发症，所有瓣膜功能良好，跨瓣压差低。患者随访及超声心动图检查显示，修复后最长8个月的结果仍然良好。
由于具有优越的生物学特性，主动脉壁有潜力在主动脉瓣修复期间提供更好的瓣叶替代物，并扩大适合自体重建的患者范围。应积累更多经验并进行随访。
