Bittira Bindu, Shurrab Mohammed, Santi Stacey, Grieve Sarah, MacDonald Derek J
Division of Cardiac Surgery, Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada.
Department of Cardiology, Health Sciences North, Sudbury, Ontario, Canada.
CJC Open. 2023 Aug 29;5(11):793-797. doi: 10.1016/j.cjco.2023.08.008. eCollection 2023 Nov.
Data are limited on long-term outcomes in patients who have undergone a reoperation following failure of a stentless aortic valve.
Between 2006 and 2016, a retrospective analysis was performed on 24 patients who underwent open aortic valve replacement surgery for a failed stentless aortic valve prosthesis at Health Sciences North, Sudbury, Ontario, Canada. The primary outcome was a low mortality rate from cardiac-related deaths after 5 years.
All patients underwent insertion of a Medtronic Freestyle bioprosthesis (Minneapolis, MN) implanted using the modified subcoronary technique for their initial operation. The interval from the first operation to the stentless redo surgery ranged from 6 to 13 years. Aortic valve reoperation was performed for structural valve deterioration in 96% (n = 23) of the cases. Reoperations involved a removal of the stented valve leaflets and standard aortic valve replacement within the stentless casing in 20% (n = 5) of the cases, with the remaining cases requiring complete removal of the stentless prosthesis and aortic valve replacement. In those in whom a complete removal of the stentless valve was possible (n = 19), no disruption of the native aortic root occurred, with a 0% rate of conversion to a Bentall procedure. No intraoperative mortality occurred. The 30-day and 10-year operative mortality rates were 4% and 16%, respectively.
Redo surgery for failing stentless valves can be done with relatively low risk and with acceptable long-term outcomes without resorting to root-replacement techniques.
关于无支架主动脉瓣失败后再次手术患者的长期预后数据有限。
2006年至2016年期间，对加拿大安大略省萨德伯里市北部健康科学中心24例因无支架主动脉瓣假体失败而接受开放性主动脉瓣置换手术的患者进行了回顾性分析。主要结局是5年后心脏相关死亡导致的低死亡率。
所有患者在初次手术时均采用改良冠状动脉下技术植入了美敦力Freestyle生物假体（明尼阿波利斯，明尼苏达州）。从首次手术到无支架再次手术的间隔时间为6至13年。96%（n = 23）的病例因结构性瓣膜退变而进行主动脉瓣再次手术。20%（n = 5）的病例再次手术包括移除带支架的瓣膜小叶并在无支架外壳内进行标准主动脉瓣置换，其余病例需要完全移除无支架假体并进行主动脉瓣置换。在那些能够完全移除无支架瓣膜的患者（n = 19）中，未发生天然主动脉根部破裂，转为Bentall手术的发生率为0%。未发生术中死亡。30天和10年手术死亡率分别为4%和16%。
对于失败的无支架瓣膜进行再次手术风险相对较低，且长期预后可接受，无需采用根部置换技术。
