二叶主动脉瓣关闭不全修复手术的早中期临床结果  

Early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency

作　　者：孙境 张帅 康文英 畅怡 赵栋 郭宏伟 钱向阳 郑哲 Sun Jing;Zhang Shuai;Kang Wenying;Chang Yi;Zhao Dong;Guo Hongwei;Qian Xiangyang;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;Department of Anesthesiology,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 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院麻醉科,北京100037

出　　处：《中华外科杂志》2024年第5期393-399,共7页Chinese Journal of Surgery

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

摘　　要：目的探讨主动脉瓣修复手术在二叶主动脉瓣关闭不全中应用的早中期临床结果。方法本研究为回顾性队列研究。回顾性分析2017年1月至2023年6月在中国医学科学院阜外医院心血管外科接受主动脉瓣修复手术的124例二叶主动脉瓣关闭不全患者的临床资料。男性117例,女性7例,年龄(38.1±12.7)岁(范围:14~65岁),根据主动脉窦部是否置换,手术方式分为保留主动脉瓣的根部替换术(主动脉根部再植术、重塑术、改良重塑术)和单纯主动脉瓣修复手术(主动脉瓣环环缩、单纯主动脉瓣叶修复)。收集患者的围手术期与随访资料。采用Kaplan-Meier法绘制生存率、免于主动脉瓣中大量关闭不全复发率及免于二次手术率曲线,组间比较采用Log-rank检验。结果主动脉根部再植术47例,主动脉根部重塑术8例,改良重塑术8例,主动脉瓣环环缩48例(成形环环缩22例,CV-0缝线环缩26例),单纯瓣叶修复13例。瓣叶折叠是最常用的瓣叶修复技术,103例患者使用。心肺转流时间为(133.7±56.9)min(范围:48~461 min),主动脉阻断时间为(103.8±47.8)min(范围:25~306 min),无手术死亡。所有患者获得随访,累积随访时间为340.3人年,随访时间[M(IQR)]34.0(25.5)个月(3~76个月),5年总体生存率为98.4%,5年免于中大量关闭不全率为93.4%,5年免于主动脉瓣二次手术率为95.6%。亚组分析结果显示,主动脉瓣环环缩患者免于主动脉瓣中大量关闭不全复发率优于瓣环未环缩患者(P=0.033)。结论主动脉瓣修复手术用于二叶主动脉瓣关闭不全患者的早中期结果良好。主动脉瓣环环缩可降低二叶主动脉瓣修复患者主动脉瓣关闭不全复发的风险。Objective To examine the early to mid-term clinical outcomes of aortic valve repair in patients with bicuspid aortic insufficiency.Methods This is a retrospective cohort study.The clinical data of 124 patients with BAV insufficiency who underwent aortic valve repair from January 2017 to June 2023 in the Department of Cardiovascular Surgery at Fuwai Hospital were analyzed retrospectively.There were 117 males and 7 females with an age of(38.1±12.7)years(range:14 to 65 years).Depending on whether the aortic sinus was replaced or not,surgical approaches were divided into valve sparing root replacement(reimplantation,remodeling,modified remodeling)and isolated aortic valve repair(annuloplasty,isolated aortic valve leaflet repair).Perioperative and follow-up data were collected.Kaplan-Meier method was used to plot the curves of survival rate,free recurrence rate of massive aortic valve insufficiency and free re-operation rate,and Log-rank test was used for comparison between groups.Results Among the surgeries,there were 47 cases of reimplantation,8 cases of remodeling,8 cases of modified remodeling,48 cases of aortic annuloplasty(external annuloplasty in 22 cases,CV-0 annuloplasty in 26 cases),and 13 cases of isolated leaflet repair.Leaflet plication was the most used leaflet repair technique,used in 103 patients.The cardiopulmonary bypass time was(133.7±56.9)minutes(range:48 to 461 minutes),and aortic cross-clamp time was(103.8±47.8)minutes(range:25 to 306 minutes),with no surgical mortality.All patients underwent outpatient or telephone follow-up.The cumulative follow-up time was 340.3 person-years and the mean follow-up time was(M(IQR))34.0(25.5)months(range:3 to 76 months).The 5-year survival rate was 98.4%,the 5-year freedom from significant insufficiency rate was 93.4% and the 5-year freedom from aortic valve reoperation rate was 95.6%.The subgroup analysis revealed a significantly better freedom from the significant insufficiency rate in the aortic valve annular reduction group compared to the non-reduction g

关 键 词：主动脉瓣关闭不全 心血管外科手术 主动脉瓣二瓣化 主动脉瓣修复 保留主动脉瓣的根部替换术 

分 类 号：R654.2[医药卫生—外科学]