自体心包主动脉瓣重建手术应用于多瓣膜修复术的单中心回顾性队列研究  

Effect of aortic valve neo-cuspidization in multiple valve repair surgery:A retrospective cohort study in a single center

作　　者：刘周 张亚哲 韩杰[1] 姜文剑[1] 张宏家[1] LIU Zhou;ZHANG Yazhe;HAN Jie;JIANG Wenjian;ZHANG Hongjia(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科中心,北京100029

出　　处：《中国胸心血管外科临床杂志》2024年第6期853-859,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：首都医科大学附属北京安贞医院重大科技创新研发专项基金(KCZD202203)。

摘　　要：目的探索在二、三尖瓣修复效果良好的基础上对合并主动脉瓣严重病变的患者施行同期自体心包主动脉瓣重建手术(aortic valve neo-cuspidization,AVNeo)的临床效果。方法回顾性分析首都医科大学附属北京安贞医院2016年5月—2023年9月因多瓣膜病变行AVNeo联合瓣膜修复手术患者的临床资料。结果共纳入11例患者,其中男7例、女4例,中位年龄38(36,49)岁。风湿性瓣膜病5例(45.5%),非风湿性病因6例(54.5%)。中位EuroSCOREⅡ评分为1.62(1.18,1.75)分。行AVNeo联合二、三尖瓣修复手术患者8例,行AVNeo联合二尖瓣修复手术患者3例。中位手术时间356(315,415)min,中位体外循环时间和主动脉阻断时间分别为203(174,231)min和168(131,188)min。AVNeo手术开展早期进行联合手术患者2例,其中1例患者术后主动脉瓣重度关闭不全院内再手术行主动脉瓣置换术。AVNeo手术成熟期联合手术患者9例,无围术期不良事件及中度以上残余瓣膜病变发生。所有患者均康复出院。随访时间3~99个月,所有患者随访期均无瓣膜再手术、无重度瓣膜病变,无出血、脑梗死等瓣膜不良事件发生。结论对于可行二、三尖瓣良好修复合并严重主动脉瓣病变的非老年患者,在熟练AVNeo手术流程后可尝试应用,但手术时间及体外循环时间仍不可避免地延长,术前需仔细评估患者基础情况。Objective To explore the effect of aortic valve neo-cuspidization(AVNeo)for patients with severe aortic valve lesions simultaneously.Methods Patients who underwent AVNeo combined valve repair surgery for multiple valve diseases were included in Beijing Anzhen Hospital from May 2016 to September 2023.Results We included 11 patients with 7 males and 4 females at a median age of 38(36,49)years.Rheumatic heart disease was found in 5(45.5%)patients and non-rheumatic heart disease in 6(54.5%)patients.The median EuroSCOREⅡscore was 1.62(1.18,1.75)points.Eight patients underwent AVNeo plus mitral and tricuspid valve repair,and 3 patients underwent AVNeo plus mitral valve repair.The median operative time was 356(315,415)min,and the median cardiopulmonary bypass time and aortic clamping time were 203(174,231)min and 168(131,188)min,respectively.In the early stage,2 patients underwent combined valve repair surgery,and 1 patient underwent in-hospital reoperation for aortic valve replacement because of severe aortic regurgitation.There were 9 patients in the mature stage of AVNeo,and no perioperative adverse events or moderate or above residual valvular disease occurred.All patients recovered and were discharged from the hospital.The follow-up period was 3-99 months,and no reoperation,severe valve disease,bleeding,cerebral infarction,or other adverse events occurred in all patients.Conclusion For non-elderly patients whose mitral and tricuspid valves can be repaired successfully with severe aortic valve lesions,AVNeo can be attempted after proficiency.But the operation time and cardiopulmonary bypass time will inevitably be prolonged,and the patient's basic situation should be carefully evaluated before surgery.

关 键 词：自体心包主动脉瓣重建手术 多瓣膜修复 回顾性队列研究 

分 类 号：R65[医药卫生—外科学]