Bicuspid aortic valve repair by complete conversion from "raphe'd'' (type 1) to "symmetric'' (type 0) morphology
Bicuspid aortic valve repair by complete conversion from "raphe'd'' (type 1) to "symmetric'' (type 0) morphology
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DOI：
10.1016/j.jtcvs.2014.05.021
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发表时间：
2014-12-01
影响因子：
6
通讯作者：
Gleason, Thomas G.
中科院分区：
文献类型：
--
作者：
Gleason, Thomas G.
目的：前尖伴中缝和假连合是最常见的二叶式主动脉瓣表型。瓣尖通常受限，瓣环附件错位，通常导致严重的主动脉瓣返流。设计了一种新的瓣膜修复策略，以创建一个对称的瓣膜，以改善功能和耐久性。方法：该技术包括通过切除正中缝，缩短前尖前缘，切除假连合，完全前环脱离，扩大、加固和前尖移位至左心室流出道更深处;保留瓣膜的主动脉根部置换术伴瓣环成形术。共有32例二尖瓣、主动脉瓣关闭不全和主动脉瓣扩张患者接受了瓣膜修复和根部置换。无手术死亡或中风发生，不需要永久性起搏器。13例患者从“中缝'd '”形态完全转化为“中缝''形态;其他患者进行了不太复杂的修复，没有移位。术后跨瓣压差保持正常。无>1+级主动脉瓣返流和瓣膜相关再手术率为100%。所有13例对称转换患者继续没有或微量主动脉瓣返流（分级
Objective: An anterior cusp with a median raphe and false commissure is the most common bicuspid aortic valve phenotype. The cusp is typically restricted and its annular attachment malpositioned, often resulting in significant aortic regurgitation. A novel valve repair strategy was designed to create a symmetric valve to improve both function and durability.Methods: The technique involves converting the valve into a "symmetric'' bicuspid valve by resection of the median raphe, with shortening of the anterior cusp's leading edge; resection of the false commissure with complete anterior annular detachment; enlargement, reinforcement, and translocation of the anterior cusp deeper into the left ventricular outflow tract; and valve-sparing aortic root replacement with concomitant annuloplasty.Results: A total of 32 patients with a bicuspid valve, aortic insufficiency, and aortic dilatation have undergone valve repair with root replacement. No operative deaths or strokes occurred, and no permanent pacemakers were required. Thirteen patients underwent complete conversion from "raphe'd'' to "symmetric'' morphology; the others underwent less complex repairs without translocation. The postoperative transvalvular gradients remained normal. Freedom from grade >1+ aortic regurgitation and valve-related reoperation was 100%. All 13 symmetric conversion patients have continued to have no or trace aortic regurgitation (grade