Repair of regurgitant bicuspid aortic valves: A systematic approach
Repair of regurgitant bicuspid aortic valves: A systematic approach
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DOI：
10.1016/j.jtcvs.2009.11.058
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发表时间：
2010-08-01
影响因子：
6
通讯作者：
El Khoury, Gebrine
中科院分区：
文献类型：
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作者：
Boodhwani, Munir;de Kerchove, Laurent;El Khoury, Gebrine
目的：二叶式主动脉瓣患者可出现由瓣尖病变或主动脉根部病变引起的主动脉瓣关闭不全。我们提出了我们13年的经验，一个功能和系统的方法，二叶式主动脉瓣repair.Methods：在1995年和2008年之间，122例（平均年龄，44 +/- 11岁）与二叶式主动脉瓣进行非紧急瓣膜修复孤立的主动脉瓣关闭不全（43%），主动脉根部扩张（14%），或两者兼而有之（43%）。术前超声心动图确定主动脉扩张（n = 75）、瓣尖脱垂（n = 96）和瓣尖限制（n = 45）为主动脉瓣关闭不全的机制。中缝修复（n = 98）通过剃毛（21%）或切除一期闭合（60%）或心包补片（18%）进行。功能性主动脉瓣环成形术采用连合下瓣环成形术（n = 51），升主动脉置换术（n - 17），或主动脉根部置换术（n - 54），采用再植入（76%）或重塑技术（24%）。5例患者接受了早期主动脉瓣再次手术（3例再次修复）。出院时，93%的患者为0/1级主动脉瓣关闭不全，7%的患者为2级。另外7例患者在随访期间接受了主动脉瓣再次手术（2例再次修复）。8年总生存率为97% +/- 3%。5年和8年随访时，无主动脉瓣再次手术率分别为94% +/- 2%和83% +/-5%，无主动脉瓣置换率分别为96% +/- 2%和90% +/-5%。5年时无复发性主动脉瓣关闭不全（> 2+）的比率为94% ± 3%。无血栓栓塞和出血是96% +/-2%8 years.Conclusion：一个系统的方法，二叶式主动脉瓣修复产生良好的早期和中期结果。主动脉瓣关闭不全的二尖瓣修复术是一种可行的和有吸引力的替代机械瓣膜置换术的年轻患者。（《胸血管外科杂志》2010;140：276-84）
Objective: Patients with bicuspid aortic valves can present with aortic insufficiency caused by cusp disease or the aortic root pathology. We present our 13-year experience with a functional and systematic approach to bicuspid aortic valve repair.Methods: Between 1995 and 2008, 122 consecutive patients (mean age, 44 +/- 11 years) with bicuspid aortic valves underwent non-emergency valve repair for isolated aortic insufficiency (43%), aortic root dilatation (14%), or both (43%). Preoperative echocardiography identified aortic dilatation (n = 75), cusp prolapse (n = 96), and cusp restriction (n = 45) as mechanisms of aortic insufficiency. Raphe repair (n = 98) was performed by shaving (21%) or resection with primary closure (60%) or pericardial patch (18%). Functional aortic annuloplasty was performed using subcommissural annuloplasty (n = 51), ascending aortic replacement (n - 17), or aortic root replacement (n - 54) using a reimplantation (76%) or remodeling technique (24%).Results: There was no operative mortality. Five patients underwent early aortic valve reoperation (3 re-repairs). At discharge, 93% of patients had aortic insufficiency grade 0/1 and 7% of patients had grade 2. Seven additional patients underwent aortic valve reoperation during follow-up (2 re-repairs). Overall survival was 97% +/- 3% at 8 years. At 5 and 8 years follow-up, freedom from aortic valve reoperation was 94% +/- 2% and 83% +/- 5%, respectively, and freedom from aortic valve replacement was 96% +/- 2% and 90% +/- 5%, respectively. Freedom from recurrent aortic insufficiency (> 2+) was 94% +/- 3% at 5 years. Freedom from thromboembolism and bleeding was 96% +/- 2% at 8 years.Conclusion: A systematic approach to bicuspid aortic valve repair yields good early and midterm results. Repair of bicuspid valves for aortic insufficiency is a feasible and attractive alternative to mechanical valve replacement in young patients. (J Thorac Cardiovasc Surg 2010;140:276-84)