Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes
Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes
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DOI：
10.1016/j.jtcvs.2008.08.054
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发表时间：
2009-02-01
影响因子：
6
通讯作者：
El Khoury, Gebrine
中科院分区：
文献类型：
--
作者：
Boodhwani, Munir;de Kerchove, Laurent;El Khoury, Gebrine
目的：主动脉瓣关闭不全的瓣膜修复需要根据瓣叶和主动脉疾病确定量身定制的手术方法。在过去的十年里，我们开发了人工智能的功能分类，它可以指导修复策略并可以预测结果。在这项研究中，我们分析了主动脉瓣修复的系统方法的经验。方法：从 1996 年到 2007 年，264 名患者因主动脉瓣关闭不全接受了选择性主动脉瓣修复术（平均年龄 -54 +/- 16 岁；79% 为男性）。 171 名患者的 AV 为三尖瓣，90 名患者为二尖瓣，3 名患者为四尖瓣。153 名患者患有 I 型功能障碍（主动脉扩张），134 名患者患有 II 型（尖瓣脱垂），40 名患者患有 III 型（限制性）。 36% (96/264) 的患者有不止一种已确定的机制。结果：院内死亡率为 1.1% (3/264)。六名患者出现早期修复失败； 3 进行了重新修复。功能分类预测了 82-100% 的患者所需的修复技术，其中高达 35% 的患者采用了辅助技术。中期随访（中位[四分位距]：47 [29 -73] 个月）显示晚期死亡率为 4.2%（11/261，10 心脏死亡率）。五年总生存率为 95 +/- 3%。 10 例患者接受了主动脉瓣再次手术（1 例再次修复）。 5 年时 A1 复发率 (>2+) 和 AV 再次手术率分别为 88 +/- 3% 和 92 +/- 4%，I 型患者 (82 +/- 9%; 93 +/- 5%) 或 II 型患者 (95 +/- 5%; 94 +/- 6%) 与 III 型患者 (76 +/- 17%; 84 +/- 13%) 相比具有更好的结果。结论：主动脉瓣修复术是主动脉瓣关闭不全患者可接受的治疗选择。这种功能分类允许采用系统方法修复 A1，并有助于预测所需的手术技术以及修复的持久性。由于纤维化或钙化而导致的限制性尖点运动（III 型）是 AV 修复后 A1 复发的重要预测因子。
Objective: Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair.Methods: From 1996 to 2007, 264 patients underwent elective aortic valve repair for aortic insufficiency (mean age -54 +/- 16 years; 79% male). AV was tricuspid in 171 patients bicuspid in 90 and quadricuspid in 3. One hundred fifty three patients had type I dysfunction (aortic dilatation), 134 had type II (cusp prolapse), and 40 had type III (restrictive). Thirty six percent (96/264) of the patients had more than one identified mechanism.Results: In-hospital mortality was 1.1% (3/264). Six patients experienced early repair failure; 3 underwent re-repair. Functional classification predicted the necessary repair techniques in 82-100% of patients, with adjunctive techniques being employed in up to 35% of patients. Mid-term follow up (median [interquartile range]: 47 [29 -73] months) revealed a late mortality rate of 4.2% (11/261, 10 cardiac). Five year overall survival was 95 +/- 3%. Ten patients underwent aortic valve reoperation (1 re-repair). Freedoms from recurrent A1 (>2+) and from AV reoperation at 5 years was 88 +/- 3% and 92 +/- 4% respectively and patients with type I (82 +/- 9%; 93 +/- 5%) or II (95 +/- 5%; 94 +/- 6%) had better outcomes compared to type III (76 +/- 17%; 84 +/- 13%).Conclusion: Aortic valve repair is an acceptable therapeutic option for patients with aortic insufficiency. This functional classification allows a systematic approach to the repair of A1 and can help to predict the surgical techniques required as well as the durability of repair. Restrictive cusp motion (type III), due to fibrosis or calcification, is an important predictor for recurrent A1 following AV repair.