Analysis of the aortic root performance in valve-sparing aortic root reconstruction.

直到最近，对于伴有主动脉环扩张或升主动脉瘤的主动脉反流患者，最好的手术治疗方法是用复合带瓣导管替代主动脉根。然而，伴有升主动脉瘤或主动脉根动脉瘤的主动脉反流主要是由于窦管连接处扩张、一个或多个Valsalva窦扭曲、主动脉环扩张或这些问题的组合。目前，临床上采用主动脉根部再植和重塑来保护原有的主动脉瓣。然而，主动脉根部是一个动态的单元，可以很容易地打开和关闭，并为瓣叶分担压力。当主动脉根部被人工材料替代时，正常的主动脉根部状况可能会丧失，主动脉瓣的开闭特性会受损。这些运动可能对修复的持久性有重要影响，并可能改善左心室功能，从而获得长期结果。虽然这些手术的短期和长期结果都很好，但哪种手术的结果更符合生理性和更持久还没有很好地确定。比较研究，包括临床结果和间接观察主动脉瓣的打开和关闭超声心动图，报告。然而，这两种技术并没有直接观察到瓣膜运动。因此，我们通过心脏内窥镜直接成像观察主动脉瓣重塑和再植手术后的行为，并研究哪种手术更符合生理性。在目前的临床情况下，被称为“David-I”的原始再植手术很少被采用。然而，我们在本研究中使用了原始再植手术，因为我们想清楚地分析重塑和再植手术之间的基本概念差异。在重塑组中，保留的主动脉瓣灵活、对称地打开和关闭，与对照组相似。同时，保存的瓣膜的游离缘通过一个心动周期被拉直。相比之下，在再植组中，保留的主动脉瓣出现屈曲和不对称运动。保留的主动脉瓣的开闭功能受到损害。此外，据推测，与再植手术相比，重塑手术可能保留更多的生理性主动脉根功能。少

Until recently, the best surgical treatment for patients with aortic regurgitation, associated with annuloaortic ectasia or an ascending aortic aneurysm, was replacement, of the aortic root with a composite valved conduit, However, aortic regurgitation with an ascending or aortic root aneurysm is mainly due to 'dilatation of the sinotubular junction, distortion of one or more of the sinuses of Valsalva, annuloaortic ectasia, or a combination of these problems. Currently, aortic root reimplantation and remodeling are performed clinically to preserve the native aortic valve using this rationale. However, the aortic root is a dynamic unit that allows easy opening and closing and shares, stress for the valve leaflets. When the aortic root is replaced with artificial material the normal aortic root condition may be lost, with impaired preserved aortic valve opening and closing characteristics. These movements could have important implications for the durability of the repair and possibly le … More ft ventricular function, and thus long-term results. Although the short-term and long-term outcomes of these operations have been good, which operation yields results that are more physiologic and more durable has not been well established. Comparative studies, including clinical results and indirect observation of opening and closing of the aortic valve using echocardiography, were reported. However, direct observation of valve motions with the two techniques was not performed. Therefore, we observed the behavior of the aortic valve after the remodeling and reimplantation procedures with direct imaging using cardiac endoscopy, and investigated which procedure is more physiologic. In the current clinical situation, the original reimplantation procedure, called "David-I", is rarely performed: However, we used the original reimplantation procedure in this study because we wanted to clearly analyze the basic conceptual differences between the remodeling and reimplantation procedures. In the remodeling group, the preserved aortic valve opened and closed flexibly and symmetrically, similar to what was seen in the control group. Also, the free margins of the preserved valve straightened through one cardiac cycle. In contrast, in the reimplantation group, the preserved aortic valve showed buckling and asymmetric motion. the opening and closing behavior of the aortic valve preserved by the reimplantation procedure was impaired. In addition, it was speculated that the remodeling procedure may preserve more physiologic aortic root function compared to the reimplantation " procedure. Less