Early results with annular support in reconstruction of the bicuspid aortic valve
Early results with annular support in reconstruction of the bicuspid aortic valve
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DOI：
10.1016/j.jtcvs.2012.11.059
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Schaefers, Hans-Joachim
中科院分区：
文献类型：
--
作者：
Aicher, Diana;Schneider, Ulrich;Schaefers, Hans-Joachim
目的：主动脉瓣关闭不全和主动脉瘤可行二叶式主动脉瓣修复术。房室交界处扩张已被确定为修复失败的风险因素，我们已经使用缝合瓣环成形术来纠正房室交界处扩大。目的是比较主动脉瓣修复与不annuloplasty.Methods的早期结果：1995年11月至1月12日，共559例患者接受了二叶式主动脉瓣修复术的主要反流（n = 389），主动脉瘤（n = 158），或急性夹层（n = 12）。对保留主动脉尺寸的主动脉瓣返流（n = 208）和窦管连接重塑加主动脉瘤和保留根部尺寸的瓣膜修复（n = 116）进行了单独瓣膜修复（主动脉瓣修复）。根重建用于涉及根的扩张（n = 235）。193例患者中，房室交界处扩张（>27 mm）通过缝合瓣环成形术纠正。结果：住院死亡率为0.5%（n = 3）; 2例患者需要植入起搏器。复发性返流（n = 54）或狭窄（n = 2）需要再次手术; 10年无再次手术率为82%，但与其他2种技术相比，孤立性瓣膜修复术（70%，P = 0.007）较差。应用缝线瓣环成形术将单独修复后3年无再次手术率（84%）提高至92%（P = 0.07）。在所有组中，没有或轻微反流的患者比例显着较高的annuloplasty.Conclusions：保留二叶式主动脉瓣在许多患者是可行的。修复瓣膜的长期稳定性良好;可通过缝合瓣环成形术减少房室交界处扩张的负面影响。（《胸血管外科杂志》2013;145：S30-4）
Objective: Repair of the bicuspid aortic valve may be performed in aortic regurgitation and aneurysm. Dilatation of the atrioventricular junction has been identified as a risk factor for repair failure, and we have used suture annuloplasty to correct atrioventricular junction enlargement. The objective was to compare the early results of aortic repair with and without annuloplasty.Methods: Between November 1995 and January 12, a total of 559 patients were treated with bicuspid aortic valve repair for predominant regurgitation (n = 389), aortic aneurysm (n = 158), or acute dissection (n = 12). Isolated valve repair (aortic valve repair) was performed for aortic valve regurgitation with preserved aortic dimensions (n = 208) and sinotubular junction remodeling plus valve repair for aortic aneurysm and preserved root size (n = 116). Root remodeling was used for dilatation involving the root (n = 235). In 193 patients, dilatation of the atrioventricular junction (>27 mm) was corrected with suture annuloplasty.Results: Hospital mortality was 0.5% (n = 3); 2 patients required pacemaker implantation. Reoperation was necessary for recurrent regurgitation (n = 54) or stenosis (n = 2); 10-year freedom from reoperation was 82% but was inferior after isolated valve repair (70%, P = .007) compared with the 2 other techniques. Application of suture annuloplasty improved 3-year freedom from reoperation after isolated repair (84%) to 92% (P = .07). In all groups, the proportion of patients with no or trivial regurgitation was significantly higher with annuloplasty.Conclusions: Preservation of the bicuspid aortic valve is feasible in many patients. Long-term stability of the repaired valves is good; the negative impact of a dilated atrioventricular junction can be reduced by suture annuloplasty. (J Thorac Cardiovasc Surg 2013;145:S30-4)