Kobayashi Kimihiro, Kuroda Yoshinori, Mizumoto Masahiro, Hayashi Jun, Hirooka Shuto, Akabane Kentaro, Ochiai Tomonori, Uchida Tetsuro
Second Department of Surgery, Faculty of Medicine, Yamagata University, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan.
Interdiscip Cardiovasc Thorac Surg. 2025 Jul 3;40(7). doi: 10.1093/icvts/ivaf150.
The valve-in-valve procedure is an alternative to the redo surgery for structural valve deterioration following the Bio-Bentall. However, the risk of coronary obstruction and the feasibility of this approach remain unclear. Using computed tomography, we compared the aortic root geometry of 14 consecutive patients (13 true aortic aneurysms) with Bio-Bentall between April 2011 and April 2024 preoperatively and postoperatively. The Piehler technique was used in all coronary artery reconstructions. During the follow-up period, no reconstructive coronary events or valve-related reoperations were observed. The coronary height was 17.7 ± 5.6 mm preoperatively versus 18.8 ± 4.4 mm postoperatively for the left coronary artery (P = 0.49) and 15.4 ± 9.6 mm preoperatively versus 22.6 ± 7.4 mm postoperatively for the right coronary artery (P < 0.01). No patients at risk of coronary obstruction associated with valve-in-valve were identified. One case of severe aortic graft kinking due to excessive graft length, which could contraindicate the valve-in-valve procedure, was observed. Our findings suggested that the Piehler technique may facilitate future valve-in-valve implantation after Bio-Bentall because it allows for a higher-positioned orifice of the reconstructive coronary artery.
瓣中瓣手术是Bio-Bentall术后因人工瓣膜结构退化而行再次手术的一种替代方案。然而，冠状动脉阻塞的风险以及该方法的可行性仍不明确。我们利用计算机断层扫描，对2011年4月至2024年4月期间连续14例（13例真性主动脉瘤）接受Bio-Bentall手术的患者术前和术后的主动脉根部几何形态进行了比较。所有冠状动脉重建均采用Piehler技术。在随访期间，未观察到冠状动脉重建相关事件或瓣膜相关再次手术。左冠状动脉术前冠状动脉高度为17.7±5.6mm，术后为18.8±4.4mm（P = 0.49）；右冠状动脉术前为15.4±9.6mm，术后为22.6±7.4mm（P < 0.01）。未发现有与瓣中瓣相关的冠状动脉阻塞风险的患者。观察到1例因人工血管过长导致严重的主动脉人工血管扭结，这可能是瓣中瓣手术的禁忌证。我们的研究结果表明，Piehler技术可能有助于Bio-Bentall术后未来的瓣中瓣植入，因为它能使重建冠状动脉的开口位置更高。
