Li Jiaao, Yang Tao, Wu Nan, Qin Yan, Gao Jianing, Liu Zhenhao, Yang Lingbo, Wang Xuening
Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, 99 Longcheng Street, Xiaodian District, Taiyuan, 030032, Shanxi, China.
Shanxi Provincial People's Hospital, Fifth Hospital of Shanxi Medical University, Taiyuan, 030012, Shanxi, China.
J Cardiothorac Surg. 2025 Jun 24;20(1):272. doi: 10.1186/s13019-025-03505-8.
To explore the application and effect of aortic annulus reconstruction (AAR) with bovine pericardium during surgical aortic valve replacement (SAVR) for severe calcific aortic stenosis (AS).
We retrospectively reviewed 12 patients with severe calcified AS who underwent bovine pericardium aortic annulus reconstruction between January 2021 to December 2023. The average age of the patients was 58 ± 8.8 years. All patients were diagnosed with severe AS, along with aortic valve and annulus calcification, through chest computed tomography (CT) and transthoracic echocardiography (TTE) prior to surgery. After the resection of severely calcified aortic annulus tissue, all patients were given a bovine pericardial patch to repair the annular defect, and five of these patients underwent Y-incision aortic annular enlargement (AAE). The patients were followed up for a duration of 0.5 to 2 years.
A total of 12 patients undergoing SAVR were enrolled, and all received bovine pericardial patches to repair the annular defects, with a mean preoperative indexed effective orifice area (iEOA) of 0.58 ± 0.098 cm²/m². The average extracorporeal circulation time during the operation was 150.83 ± 34.5 min, and the average cross-clamp time was 95.42 ± 17.46 min. Postoperative evaluations indicated that the structural integrity of the valve annulus remained intact, demonstrating hemodynamic stabilization without any recorded fatalities among participants. Compared to preoperative levels, the aortic valve mean gradient (4.67 ± 1.15 vs. 59.67 ± 17.94 mmHg, P < 0.001), peak gradient (13 [10-15.75] vs. 92 [82.25-110.25] mmHg, P < 0.001), mean aortic jet velocity (99.67 ± 15.44 vs. 367.17 ± 58.13 cm/s, P < 0.001), and peak aortic jet velocity (182.25 ± 23.40 vs. 495.67 ± 61.74 cm/s, P < 0.001) significantly decreased after 0.5 years of follow-up. There were no complications such as hemolysis, perivalvular leakage, thrombosis or endocarditis during follow-up.
In patients with severe calcified AS, the AAR technique using bovine pericardium during SAVR is safe and effective, with stable hemodynamic performance and satisfactory clinical outcomes.
探讨在严重钙化性主动脉瓣狭窄（AS）的外科主动脉瓣置换术（SAVR）中应用牛心包进行主动脉瓣环重建（AAR）的方法及效果。
回顾性分析2021年1月至2023年12月期间12例行牛心包主动脉瓣环重建术的严重钙化性AS患者。患者平均年龄58±8.8岁。所有患者术前均经胸部计算机断层扫描（CT）和经胸超声心动图（TTE）诊断为严重AS，伴有主动脉瓣和瓣环钙化。切除严重钙化的主动脉瓣环组织后，所有患者均采用牛心包补片修复瓣环缺损，其中5例患者行Y形切口主动脉瓣环扩大术（AAE）。对患者进行了0.5至2年的随访。
共纳入12例行SAVR的患者，均接受牛心包补片修复瓣环缺损，术前平均指数有效瓣口面积（iEOA）为0.58±0.098cm²/m²。术中平均体外循环时间为150.83±34.5分钟，平均主动脉阻断时间为95.42±17.46分钟。术后评估表明瓣环结构完整性保持完好，并显示血流动力学稳定，随访期间无死亡病例。与术前水平相比，随访0.5年后主动脉瓣平均压差（4.67±1.15 vs. 59.67±17.94mmHg，P<0.001）、峰值压差（13[10 - 15.75] vs. 92[82.25 - 110.25]mmHg，P<0.001）、平均主动脉喷射速度（99.67±15.44 vs. 367.17±58.13cm/s，P<0.001）和峰值主动脉喷射速度（182.25±23.40 vs. 495.67±61.74cm/s，P<0.001）均显著降低。随访期间未出现溶血、瓣周漏、血栓形成或心内膜炎等并发症。
在严重钙化性AS患者中，SAVR期间使用牛心包的AAR技术安全有效，血流动力学性能稳定，临床效果满意。
