Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2024 Jan;117(1):45-53. doi: 10.1016/j.athoracsur.2023.09.027. Epub 2023 Sep 29.
Aortic valve-sparing operations were developed >3 decades ago and have become part of the surgical armamentarium to treat patients with aortic root and ascending aortic aneurysms. Although remodeling of the aortic root is physiologically sounder than reimplantation of the aortic valve, most surgeons seem to prefer the latter. This review summarizes the views of one of the pioneers of aortic valve-sparing operation and includes their development, the various modifications that occurred over the years, comparative outcomes with aortic root replacement with valved conduits, outcomes from several recently reported series, and the future directions. The author argues that comparisons between aortic valve-sparing operations and aortic root replacement with valved conduits based on retrospective studies are inappropriate because these 2 types of surgery are performed in patients with different aortic valve pathology. Late outcomes after aortic valve-sparing operations have not been consistent among various reports and raise the question of surgical expertise and patients' selection. Aortic valve-sparing operations are the best treatment for young patients with aortic root aneurysm and normal aortic cusps. Further studies are needed to define their role in the management of patients with diseased aortic cusps.
主动脉瓣保留手术是 30 多年前发展起来的，现已成为治疗主动脉根部和升主动脉瘤患者的外科治疗手段之一。虽然主动脉根部重塑在生理上比主动脉瓣再植入更合理，但大多数外科医生似乎更喜欢后者。这篇综述总结了主动脉瓣保留手术的先驱之一的观点，包括其发展、多年来发生的各种改良、与带瓣管道主动脉根部置换的对比结果、最近报道的几个系列的结果以及未来的发展方向。作者认为，基于回顾性研究的主动脉瓣保留手术和带瓣管道主动脉根部置换之间的比较是不合适的，因为这两种手术是在具有不同主动脉瓣病理的患者中进行的。主动脉瓣保留手术后的晚期结果在不同的报告中并不一致，这引发了关于手术技术和患者选择的问题。主动脉瓣保留手术是治疗主动脉根部瘤和正常主动脉瓣叶的年轻患者的最佳方法。需要进一步的研究来确定它们在治疗有病变的主动脉瓣叶患者中的作用。
