Kitamura M, Satoh M, Hachida M, Endo M, Hashimoto A, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
J Heart Valve Dis. 1996 Nov;5 Suppl 3:S289-93.
Surgical treatments for aortic valve disease in the presence of a small aortic annulus need appropriate indications for operative procedures and precise selection of valve prostheses. The objective of this study was to compare long term results after aortic annular enlargement with those after operation using a small valve prosthesis.
Since 1980, 45 patients with small aortic annulus underwent operation at our institution. There were six men and 39 women, and their ages ranged from 16 to 69 with a mean of 45.6 years. Of these patients, 28 underwent aortic annular enlargements (Nicks' procedure in 13, Manouguian's in 12 and apico-aortic bypass in three patients) and 17 patients received standard aortic valve replacement with a small valve prosthesis (19 mm Standard St. Jude Medical). Mean follow up was 8.6 years in the enlargement group and 4.9 years in the standard group.
Early mortality was 3.6% (1/28) in the enlargement group and 5.9% (1/17) in the standard group (NS). The 10-year actuarial survival including all deaths was 85.7% in the enlargement group and 62.7% in the standard group (p < 0.10). The rate of freedom from reoperation at 10 years was 90.7% in the enlargement group and 93.8% in the standard group (NS). The 10-year freedom from all valve-related events was 81.0% in the enlargement group and 58.8% in the standard group (p < 0.05).
The above results suggest that long term mortality and morbidity after aortic annular enlargement might be superior to those after standard AVR with a small valve prosthesis.
对于主动脉瓣环较小的主动脉瓣疾病患者，手术治疗需要为手术操作选择合适的指征，并精确挑选瓣膜假体。本研究的目的是比较主动脉瓣环扩大术后与使用小瓣膜假体手术后的长期结果。
自1980年以来，我院对45例主动脉瓣环较小的患者进行了手术。其中男性6例，女性39例，年龄在16至69岁之间，平均年龄为45.6岁。这些患者中，28例行主动脉瓣环扩大术（13例采用尼克斯手术，12例采用马努吉安手术，3例采用心尖 - 主动脉旁路术），17例接受标准主动脉瓣置换术，使用小瓣膜假体（19mm标准圣犹达医疗瓣膜）。扩大术组平均随访8.6年，标准组平均随访4.9年。
扩大术组早期死亡率为3.6%（1/28），标准组为5.9%（1/17）（无统计学差异）。包括所有死亡病例在内，扩大术组10年精算生存率为85.7%，标准组为62.7%（p < 0.10）。扩大术组10年再次手术率为90.7%，标准组为93.8%（无统计学差异）。扩大术组10年无所有瓣膜相关事件发生率为81.0%，标准组为58.8%（p < 0.05）。
上述结果表明，主动脉瓣环扩大术后的长期死亡率和发病率可能优于使用小瓣膜假体的标准主动脉瓣置换术。
