Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair
Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair
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DOI：
10.1016/j.jtcvs.2011.08.021
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发表时间：
2011-12-01
影响因子：
6
通讯作者：
El Khoury, Gebrine
中科院分区：
文献类型：
--
作者：
de Kerchove, Laurent;Boodhwani, Munir;El Khoury, Gebrine
目的：为了评估二叶式主动脉瓣修复术中的根部置换和瓣环稳定性，我们比较了再植入技术与连合下瓣环成形术或无瓣环成形术的结果。接受连合下瓣环成形术或未接受瓣环成形术的患者（第1组，n = 87）与接受再植入技术的患者（第2组，n = 74）相比，根部尺寸更大，主动脉瓣关闭不全更少。我们根据这些标准将第1组与第1组配对。匹配后（每组n = 106，n = 53），牙根尺寸（41.5 +/- 5 vs 40 +/- 4 mm; P = .2）和关闭不全程度（2.6 +/- 1.2 vs 2.7 +/- 1; P = .6）组间相似。第2组术前左心室尺寸较小（P -0.02），伴随手术较少（P -0.02），随访时间较短（41 +/- 30 vs 63 +/- 40个月; P = 0.003）。无院内死亡。出院时，两组间残余主动脉瓣关闭不全相似，但第1组的峰值压差大于25 mm Hg更常见（13% vs 30%; P = 0.04）。6年时，两组的总生存率均为98% ± 3%。第2组的再次手术和主动脉瓣关闭不全大于2+的自由度明显更好（100% vs 90% +/- 8%; P = 0.03; 100% vs 77% +/- 14%; P = 0.002）。在二叶式主动脉瓣修复术中，采用再植技术进行根部置换可稳定心室-主动脉交界处，改善瓣膜活动度，（低梯度），并与改善的结果。（《胸血管外科杂志》2011;142：1430-8）
Objectives: To assess root replacement and annular stabilization in bicuspid aortic valve repair, we compared results of reimplantation technique versus subcommissural annuloplasty or no annuloplasty.Methods: Between 1995 and 2010, 161 consecutive patients underwent bicuspid aortic valve repair. Patients undergoing subcommissural annuloplasty or no annuloplasty (group 1, n = 87) had larger root dimensions and less aortic insufficiency than did patients undergoing reimplantation technique (group 2, n = 74). We matched groups 1 to 1 on basis of those criteria. After matching (n = 106, n = 53 per group), root dimensions (41.5 +/- 5 vs 40 +/- 4 mm; P = .2) and degree of insufficiency (2.6 +/- 1.2 vs 2.7 +/- 1; P = .6) were similar between groups.Results: Techniques of cusp repair were similar between groups. Group 2 had smaller preoperative left ventricular size (P - .02), fewer concomitant procedures (P - .02), and shorter follow-up (41 +/- 30 vs 63 +/- 40 months; P = .003). There were no in-hospital deaths. At discharge, residual aortic insufficiency was similar between groups, but peak gradient greater than 25 mm Hg was more frequent in group 1 (13% vs 30%; P = .04). At 6 years, overall survival was 98% +/- 3% in both groups. Freedoms from reoperation and aortic insufficiency greater than 2+ were significantly better in group 2 (100% vs 90% +/- 8%; P = .03; 100% vs 77% +/- 14%; P = .002).Conclusions: In bicuspid aortic valve repair, root replacement with the reimplantation technique stabilizes the ventriculoaortic junction, improves valve mobility (low gradient), and is associated with improved outcomes. (J Thorac Cardiovasc Surg 2011;142:1430-8)