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

保留瓣膜主动脉根部重建中主动脉根部性能分析。

• 批准号: 13470276
• 负责人: ITOH Tsuyoshi
• 金额: $ 7.87万
• 依托单位: Saga University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 2001
• 资助国家: 日本
• 起止时间: 2001 至 2003
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-13470276/
• 关键词: Aortic root reconstruction; Valve-sparing operation; Aortic valve; Aortic root remodeling; Aortic root reimplantation; Ross operation; sino-tubular junction; Cardiac endoscopy; re-medeling法; re-implantaion法

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

直到最近，对于与主动脉瓣环扩张或升主动脉瘤相关的主动脉瓣返流患者，最好的外科治疗是用复合瓣膜管道置换主动脉根。然而，主动脉瓣返流与升主动脉或主动脉根动脉瘤主要是由于窦管连接处的扩张、一个或多个主动脉窦的扭曲、主动脉瓣环扩张、或者这些问题的组合。目前，临床上使用该原理进行主动脉根部再植和重塑以保留天然主动脉瓣。然而，主动脉根是一个动态单元，允许容易地打开和关闭，并为瓣叶分担应力。当主动脉根部被人工材料替换时，正常的主动脉根部条件可能会丧失，同时受损的保留的主动脉瓣打开和关闭特性。这些运动可能对修复的耐久性有重要影响， ...更多信息 FT心室功能，从而长期结果。虽然这些手术的短期和长期结果都很好，但哪种手术产生的结果更符合生理和更持久还没有得到很好的确定。报告了比较研究，包括临床结果和使用超声心动图间接观察主动脉瓣的打开和关闭。然而，没有使用这两种技术直接观察瓣膜运动。因此，我们使用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，并研究哪种手术更具生理性。在目前的临床情况下，很少进行称为“David-I”的原始再植术：然而，我们在本研究中使用原始再植术，因为我们想清楚地分析重塑和再植术之间的基本概念差异。重建组主动脉瓣开闭灵活、对称，与对照组相似。此外，保留瓣膜的游离缘在一个心动周期内变直。相比之下，在再植入组中，保留的主动脉瓣表现为屈曲和不对称运动。通过再植入手术保留的主动脉瓣的打开和关闭行为受损。此外，据推测，与再植术相比，重塑术可能保留更多的生理性主动脉根部功能。少

项目成果

Furukawa K, Okazaki Y, Ohtsubo S, Itoh T, et al.: "Evaluation of native valve-sparing aortic root reconstruction with direct imaging -reimplantation or remodeling?"Ann Thorac Surg. 77. 1636-1641 (2004)

Furukawa K、Okazaki Y、Ohtsubo S、Itoh T 等人：“通过直接成像评估保留自体瓣膜的主动脉根部重建 - 再植入还是重塑？”Ann Thorac Surg。

Okazaki Y, Furukawa K, Ohtsubo S, Natsuaki M, Itoh T, et al.: "Distensibility of the pulmonary autograft under systemic pressure."Journal of Heart Valve Disease. 11. 231-235 (2002)

Okazaki Y、Furukawa K、Ohtsubo S、Natsuaki M、Itoh T 等：“全身压力下自体肺移植物的扩张性”。《心脏瓣膜病杂志》。

Ohtsubo S, Itoh T, Furukawa K, Okazaki Y, Natsuaki M, et al.: "Geometrical difference between an ascending aneurysm and a root aneurysm in valve-sparing operations"Japanese Journal of Thoracic and Cardiovascular Surgery. 50. 59-65 (2002)

Ohtsubo S、Itoh T、Furukawa K、Okazaki Y、Natsuaki M 等人：“保留瓣膜手术中升行动脉瘤和根部动脉瘤之间的几何差异”日本胸心血管外科杂志。

Natsuaki M, Itoh T, Okazaki Y, Furukawa K, Ohtsubo S, et al.: "Influence of St.Jude medical valve in patients with aortic stenosis and small aortic annulus on cardiac function and late survival result."Artificial Organs. 26. 840-846 (2002)

Natsuaki M、Itoh T、Okazaki Y、Furukawa K、Ohtsubo S 等人：“主动脉瓣狭窄和小主动脉环患者使用 St.Jude 医用瓣膜对心脏功能和晚期生存结果的影响。”人工器官。

大坪 諭, 伊藤 翼: "大動脈弁輪拡張症 自己弁温存大動脈基部再建術.田邊達三監修,安田慶秀 編集:エキスパートに学ぶ大動脈瘤手術"メディカルレビュー社, 東京. 241 (2003)

Satoshi Otsubo，Tsubasa Ito：“主动脉瓣环扩张的自体瓣膜保留主动脉根部重建。Tatsuzo Tanabe 监督，Yoshihide Yasuda 编辑：从专家那里学到的主动脉瘤手术，”Medical Review Company，东京 241 (2003)。