Repair of aortic leaflet prolapse: a ten-year experience
Repair of aortic leaflet prolapse: a ten-year experience
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DOI：
10.1016/j.ejcts.2008.06.030
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发表时间：
2008-10-01
影响因子：
3.4
通讯作者：
El Khoury, Gebrine
中科院分区：
文献类型：
--
作者：
de Kerchove, Laurent;Glineur, David;El Khoury, Gebrine
目的：小叶折叠术 (PL)、三角切除术 (TR)、Gore-Tex 连续缝合重新悬挂 (GTx) 和自体心包补片延伸 (PP) 是修复主动脉瓣关闭不全 (Al) 的主动脉小叶脱垂 (LP) 的不同技术。在这项研究中，我们报告并比较了这些主动脉瓣修复技术的早期和中期结果。方法：从1996年到2006年，298名患者接受了选择性主动脉瓣（AV）修复术。其中 146 例中发现 1 个（n = 72）或多于 1 个小叶（n = 74）脱垂。 LP 被定义为与其他小叶相比更长或更低的小叶自由边缘，或者所有小叶的接合水平相对较低。当小叶组织质量良好（薄而柔韧）时，采用 GTx（n = 39）、PL（n = 25）或 GTx + PL（n = 23）治疗脱垂。当瓣叶组织质量差（增厚、钙化）时，采用 TR 或 PP (n = 13) 或 TR 或 PP + GTx (n = 47) 治疗脱垂。结果：无住院死亡病例。在最初住院期间，两名患者因复发性 Al 需要再次手术，一名患者因主动脉右心室瘘需要再次手术；其中，有两处被重新修复。中位随访时间为 35 个月（范围 9-136）。 3 名患者因复发性 Al 需要晚期再次手术。 4 年时，总生存率为 99 +/- 1%，免于再次手术和复发性 Al（级别 > 2）的情况分别为 94 +/- 5% 和 91 +/- 7%。在进行一次或多次 LP 修复的患者中，无复发性 Al 的情况相似（88 +/- 11% 与 92 +/- 8%，p = 0.2），以及用于修复高质量传单的不同技术（PL：95 +/- 8% vs GTx：83 +/- 18% vs PL + GTx：100%；p = 0.37）。当需要进行小叶切除时，添加 GTx 显着减少 Al 的复发（TR 或 PP：82 +/- 18% vs TR 或 PP + GTx：97 +/- 4%；p = 0.026）。结论：小叶折叠术和 Gore-Tex 重悬术都是主动脉小叶前垂酶修复的有效且持久的技术。将 Gore-Tex 添加到三角切除和心包补片修复技术中，可有效加固缝合线并改善修复效果。即使没有明确的参考水平（例如正常小叶），只要实现正常的解剖接合，多叶脱垂也不是成功修复的阻碍因素。 (C) 2008 年欧洲心胸外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objective: Leaflet plication (PL), triangular resection (TR), resuspension with running suture of Gore-Tex (GTx) and extension with autologous pericardial patch (PP) are different techniques to repair aortic leaflet prolapse (LP) for aortic insufficienty (Al). In this study, we report and compare the early and mid-term results of these techniques for aortic valve repair. Methods: From 1996 to 2006, 298 patients underwent elective aortic valve (AV) repair. In 146 of them, prolapse of one (n = 72) or more than one leaflet (n = 74) was found. LP was defined either as a longer or lower leaflet free margin compared to the other leaflet(s) or a relatively low coaptation level of all leaflets. When leaflet tissues were of good quality (thin and pliable), prolapse was treated by GTx (n = 39), PL (n = 25) of GTx + PL (n = 23). When leaflet tissues were of poor quality (thickened, calcified), prolapse was treated by TR or PP (n = 13) or TR or PP + GTx (n = 47). Results: There was no hospital mortality. During the initial hospitalization two patients required reoperation for recurrent Al and one for aorto-right ventricular fistula; of them, two were re-repaired. Median follow-up was 35 months (range 9-136). Three patients needed late reoperation for recurrent Al. At 4 years, overall survival was 99 +/- 1% and freedom from reoperation and from recurrent Al (grade > 2) was 94 +/- 5% and 91 +/- 7% respectively. Freedom from recurrent Al was similar in patients having one versus more than one LP repair (88 +/- 11% vs 92 +/- 8%, p = 0.2) and among the different techniques used to repair leaflet of good quality (PL: 95 +/- 8% vs GTx: 83 +/- 18% vs PL + GTx: 100%; p = 0.37). When leaflet resection was needed, the addition of GTx significantly reduced the recurrence of Al (TR or PP: 82 +/- 18% vs TR or PP + GTx: 97 +/- 4%; p = 0.026). Conclusions: Leaflet plication and Gore-Tex resuspension are both effective and durable techniques for aortic leaflet proplase repair. The addition of Gore-Tex to triangular resection and pericardial patch repair techniques is efficient to reinforce the suture line and to improve the outcome of the repair. Multiple leaflet prolapse is not a prohibitive factor for successful repair even in the absence of a clear reference level such as a normal leaflet, as long as normal anatomical coaptation is achieved. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.