Chemtob Raphaelle A, Rajeswaran Jeevanantham, Kalahasti Vidyasagar, Griffin Brian P, Desai Milind Y, Kapadia Samir R, Blackstone Eugene H, Karamlou Tara, Svensson Lars G
Department of Thoracic and Cardiovascular Surgery, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2025 Jul;170(1):126-134.e6. doi: 10.1016/j.jtcvs.2024.08.025. Epub 2024 Aug 23.
Valve-sparing aortic root replacement for proximal aortic dilation with aortic regurgitation is associated with excellent outcomes. Modified aortic reimplantation entails reducing the anulus size to the expected size for sex and body surface area and creating neosinuses to preserve the aortic valve. We present our mid- and late-term outcomes with the modified technique, including a single-surgeon's experience over the past 2 decades.
From January 2002 to January 2024, 528 patients underwent modified aortic reimplantation for aortic aneurysm or dilation; 491 were included in this study. End points included time-related mortality and postoperative morbidities, including aortic valve reintervention and longitudinal aortic regurgitation grade.
There were no operative deaths. Survival at 30 days, 1 year, and 15 years were 100%, 99.6%, and 87%, respectively. Postoperative stroke occurred in 4 patients (0.81%) and reoperation for bleeding in 7 (1.4%). Moderate or severe aortic valve regurgitation was seen in 6.2% and 10% of patients at 1 and 10 years, respectively. Aortic valve mean gradients were 7.0 and 7.5 mm Hg at 1 and 10 years, respectively. Freedom from reintervention on the aortic valve was 99.9%, 99%, and 95% at 30 days, 1 year, and 15 years, respectively.
Modified aortic reimplantation technique is a reliable and reproducible technique with excellent mid- and long-term outcomes in survival and freedom from reintervention. The results advocate for modified reimplantation in patients with enlarged aortic roots, especially in younger patients with connective tissue disorder.
对于近端主动脉扩张合并主动脉反流的患者，保留瓣膜的主动脉根部置换术具有出色的治疗效果。改良主动脉再植入术需要将瓣环尺寸缩小至根据性别和体表面积预期的大小，并创建新的主动脉窦以保留主动脉瓣。我们展示了采用改良技术的中期和长期治疗效果，包括一位外科医生在过去20年中的经验。
从2002年1月至2024年1月，528例患者因主动脉瘤或扩张接受了改良主动脉再植入术；本研究纳入了491例患者。终点指标包括与时间相关的死亡率和术后并发症，包括主动脉瓣再次干预和主动脉反流纵向分级。
无手术死亡病例。30天、1年和15年的生存率分别为100%、99.6%和87%。4例患者（0.81%）发生术后卒中，7例患者（1.4%）因出血接受再次手术。1年和10年时分别有6.2%和10%的患者出现中度或重度主动脉瓣反流。1年和10年时主动脉瓣平均压差分别为7.0和7.5 mmHg。30天、1年和15年时主动脉瓣免于再次干预的比例分别为99.9%、99%和95%。
改良主动脉再植入术是一种可靠且可重复的技术，在生存和免于再次干预方面具有出色的中期和长期治疗效果。这些结果支持对主动脉根部扩大的患者，尤其是患有结缔组织疾病的年轻患者采用改良再植入术。
