Luo X J, Wang S Y, Qiu J T, Li X S, Zhang P, Wang Y T, Yu C T
Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China.
Zhonghua Wai Ke Za Zhi. 2025 Jul 1;63(7):618-623. doi: 10.3760/cma.j.cn112139-20240816-00377.
To investigate the feasibility and clinical outcome of estimating the target length of the free margin of the leaflet by diameter of the prosthesis graft used to reconstruct the aortic root during the modified root remodeling procedure. This is a retrospective case series study. The clinical data of 11 patients with aortic root aneurysm who underwent modified aortic root remodeling procedure with external sub-valvular ring from July 2021 to May 2024 at Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed. The age of the patients was (42.3±14.4) years (range:23 to 61 years), including 9 males and 2 females. The aortic valve of all patients was tri-leaflet configuration. Marfan syndrome was diagnosed in 3 cases. The diameter of the prosthesis graft was determined according to the Lansac group's criteria based on the diameter of the aortic annulus, and a graft ring of the same diameter was used as the external sub-valvular ring. The free margin of the leaflet was treated with central plication according to the standard of "target length of free margin of the leaflet=the diameter of the selected graft+3 to 5 mm". The surgical results and postoperative aortic valve closure function were observed. All 11 patients successfully completed the operation without in-hospital death or complications. The graft with a diameter of 28 mm were used in 7 cases, 26 mm in 3 cases, and 30 mm in 1 case. 4 patients required central plication of the free margin of 3 leaflets, 2 patients required treatment of 2 leaflets, 3 patients required treatment of 1 leaflet, and 2 patients did not need treatment of the free margin of the leaflets. The functional status of aortic valve closure was significantly improved in all patients after surgery, and the degree of residual aortic regurgitation was not more than mild. After reconstruction of the aortic root, the measured effective height was (8.8±1.3) mm (range:7 to 11 mm) and the measured coaptation length was (5.2±0.9) mm (range:4 to 7 mm). All patients were re-examined 3 months after surgery. Echocardiography showed that the degree of aortic regurgitation was mild or lower, and the left ventricular end-diastolic diameter was (49.4±6.1) mm (range: 36 to 56 mm), which was smaller than that before the operation ((58.5±7.0) mm (range: 47 to 72 mm)). Eight patients were followed up for more than 6 months, and 5 patients were followed up for more than 1 year. The degree of aortic regurgitation in these patients was mild or below. The method based on the diameter of the selected prosthesis graft to deal with the length of the free margin of the leaflet can be effectively used in the modified aortic root remodeling procedure with external sub-valvular ring. The early postoperative results are satisfactory
探讨在改良根部重塑手术中，根据用于重建主动脉根部的人工血管直径来估算瓣叶游离缘目标长度的可行性及临床效果。这是一项回顾性病例系列研究。分析了2021年7月至2024年5月在中国医学科学院北京协和医学院阜外医院心血管外科接受带外部瓣下环的改良主动脉根部重塑手术的11例主动脉根部瘤患者的临床资料。患者年龄为（42.3±14.4）岁（范围：23至61岁），其中男性9例，女性2例。所有患者的主动脉瓣均为三叶结构。3例诊断为马凡综合征。根据Lansac组基于主动脉瓣环直径的标准确定人工血管直径，并使用相同直径的人工血管环作为外部瓣下环。按照“瓣叶游离缘目标长度=所选人工血管直径+3至5毫米”的标准对瓣叶游离缘进行中央折叠处理。观察手术结果及术后主动脉瓣关闭功能。11例患者均成功完成手术，无院内死亡或并发症。7例使用直径28毫米的人工血管，3例使用26毫米的，1例使用30毫米的。4例患者需要对3个瓣叶的游离缘进行中央折叠，2例患者需要处理2个瓣叶，3例患者需要处理1个瓣叶，2例患者不需要处理瓣叶游离缘。术后所有患者主动脉瓣关闭功能状态均显著改善，残余主动脉反流程度不超过轻度。主动脉根部重建后，测得的有效高度为（8.8±1.3）毫米（范围：7至11毫米），测得的对合长度为（5.2±0.9）毫米（范围：4至7毫米）。所有患者术后3个月进行复查。超声心动图显示主动脉反流程度为轻度或更低，左心室舒张末期内径为（49.4±6.1）毫米（范围：36至56毫米），小于术前（（58.5±7.0）毫米（范围：47至72毫米））。8例患者随访超过6个月，5例患者随访超过1年。这些患者的主动脉反流程度为轻度或以下。基于所选人工血管直径处理瓣叶游离缘长度的方法可有效应用于带外部瓣下环的改良主动脉根部重塑手术。术后早期结果满意
