主动脉瓣修复术的历史、现状和未来  

Aortic valve repair surgery:a historical review,current analysis,and future prospects

作　　者：孙境 郑哲 Sun Jing;Zheng Zhe(Department of Cardiovascular Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院心血管外科,北京100037

出　　处：《中华外科杂志》2024年第5期364-369,共6页Chinese Journal of Surgery

基　　金：北京市科学技术委员会资助项目(Z201100005520003)。

摘　　要：主动脉瓣修复术是一种古老的手术方式,它与主动脉瓣置换术同时起步,但由于效果不佳逐渐被舍弃。目前主动脉瓣置换术已成为主动脉瓣功能障碍伴或不伴主动脉根部病变患者的首选治疗方法。由于人工瓣膜面临衰败和抗凝相关并发症,主动脉瓣修复术再次成为一种治疗选择,它避免了人工瓣膜相关的长期风险,但存在主动脉瓣关闭不全复发的风险。主动脉根部重塑术和再植术两种划时代手术的出现,降低了关闭不全复发的风险。主动脉根部功能解剖概念与主动脉瓣关闭不全机制的提出与确立奠定了现代主动脉瓣修复的理论基础。主动脉瓣修复成为一种涉及瓣环、窦部、窦管交界、瓣叶等的综合修复策略,患者术后远期生存率接近健康人群,瓣膜相关再干预率与瓣膜置换术相似,逐渐成为主动脉瓣关闭不全伴或不伴主动脉根部病变患者的一种替代治疗方式。Aortic valve repair surgery is an ancient surgical approach.It is ancient in the sense that it emerged alongside aortic valve replacement surgery,but was gradually abandoned due to suboptimal outcomes.Currently,aortic valve replacement surgery has become the preferred method for treating patients with aortic valve dysfunction,with or without aortic root lesions.However,due to the risks of prosthetic valve deterioration and anticoagulation-related complications,aortic valve repair surgery has re-emerged as an attractive treatment option,avoiding the long-term risks associated with prosthetic valves.However,it comes with the risk of recurrence of valve regurgitation.Remodeling and reimplantation are milestones in aortic valve repair,reducing the risk of aortic regurgitation.The concept of functional anatomy of the aortic root and the mechanism of aortic regurgitation lay the theoretical foundation for modern aortic valve repair.Aortic valve repair has become a comprehensive repair strategy that involves the basal ring,sinus,sino-tubular junction,and aortic lobes.The long-term survival rate is close to that of the normal population,and the valvular-related reintervention rate is comparable to that of valve replacement.Aortic valve repair is gradually becoming a novel alternative treatment for patients with aortic valve insufficiency,with or without aortic root lesions.

关 键 词：主动脉瓣关闭不全 心血管外科手术 主动脉瓣修复术 主动脉瓣置换术 再手术 

分 类 号：R654.2[医药卫生—外科学]