二叶主动脉瓣反流病变三维解剖修复的治疗效果  

Therapeutic results of three-dimensional aortic valve anatomic repair for regurgitant bicuspid aortic valve

作　　者：李军 王春生 左政 赖颢 董丽莉[2] 朱铠 翟骏宇 孙勇新 丁文军 洪涛 Li Jun;Wang Chunsheng;Zuo Zheng;Lai Hao;Dong Lili;Zhu Kai;Zhai Junyu;Sun Yongxin;Ding Wenjun;Hong Tao(Department of Cardiovascular Surgeryy,,Zhongshan Hospital,Fudan University,Shanghai Cardiovascular Diseases Institute,Shanghai 200032,China;Department of Echocardiography,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心外科上海市心血管病研究所,上海200032 [2]复旦大学附属中山医院心超诊断科,上海200032

出　　处：《中华外科杂志》2024年第11期1024-1031,共8页Chinese Journal of Surgery

基　　金：上海市“科技创新行动计划”自然科学基金(23ZR1459000)。

摘　　要：目的:探讨三维解剖修复术治疗二叶主动脉瓣反流的技术要点及效果。方法:本研究为回顾性病例系列研究。连续纳入2021年8月至2023年12月于复旦大学附属中山医院心外科诊断为二叶主动脉瓣反流并行三维解剖修复术的130例患者的临床资料。其中男性115例(88.5%),女性15例(11.5%),年龄(38.6±11.7)岁(范围:15~67岁)。所有患者采用改良主动脉袖式根部重塑技术对基底环、主动脉窦及窦管交界同时行三维立体瓣环重塑。收集围手术期资料并结合随访数据进行分析。组间比较采用配对样本t检验、Wilcoxon配对符号秩和检验或χ^(2)检验。结果:全部患者顺利完成三维解剖修复,无中转主动脉瓣置换术者。体外循环时间[M(IQR)]109(34)min(范围:67~247 min);主动脉阻断时间76(26)min(范围:32~158 min)。经食道超声心动图检查结果示术前123例(94.6%)患者合并中、重度反流;术后即刻无反流22例(16.9%),轻微反流81例(62.3%),轻度反流27例(20.8%)。患者均获得随访,随访时间5.5(9.4)个月(范围:0.1~27.6个月)。末次随访行超声心动图检查者112例,其中无反流4例(3.6%),轻微反流58例(51.8%),轻度反流45例(40.2%),中度反流4例(3.6%),重度反流1例(0.9%)。结论:对于瓣膜质地较好且不合并主动脉窦严重扩张的二叶主动脉瓣反流患者,注重主动脉根部整体重塑的三维解剖修复术的近期疗效满意。Objective To explore the surgical technique and results of three-dimensional aortic valve anatomic repair for bicuspid aortic valve(BAV)with aortic regurgitation(AR).Methods This is a retrospective case series study.From August 2021 to December 2023,130 consecutive patients with BAV-AR underwent aortic valve anatomic repair at the Department of Cardiothoracic Surgery,Zhongshan Hospital,Fudan University,and the data were retrospectively analyzed.There were 115 males and 15 females,aged(38.6±11.7)years(range:15 to 67 years).All patients received modified aortic root reconstruction,to do three-dimensional root remodeling,including the basal ring,sinus of Valsalva and sino-tubular junction simultaneously.Perioperative and follow-up data were collected and analyzed.Comparisons between groups were performed using independent samples t-test,Wilcoxon paired signed-rank test,orχ^(2)test.Results No patient transferred to valve replacement during the operation.The cardiopulmonary bypass time(M(IQR))was 109(34)minutes(range:67 to 247 minutes),and the aortic cross-clamp time was 76(26)minutes(range:32 to 158 minutes).Preoperative transesophageal echocardiography showed 123 patients(94.6%)presented with moderate or severe regurgitation.Immediately postoperative transesophageal echocardiography showed no regurgitation in 22 patients(16.9%),trace regurgitation in 81 patients(62.3%)and mild regurgitation in 27 patients(20.8%).Follow up was completed in all patients,with a follow-up of 5.5(9.4)months(range:0.1 to 27.6 months).No mortality was observed during follow-up.Echocardiography was obtained in 112 patients at the latest follow-up,including no regurgitation in 4 patients(3.6%),trace regurgitation in 58 patients(51.8%),mild regurgitation in 45 patients(40.2%),moderate regurgitation in 4 patients(3.6%),and severe regurgitation in 1 patient(0.9%).Conclusion For patients with BAV-AR who have good valve quality and no severe aortic sinus dilation,the recent outcomes of three-dimensional anatomical repair technique,focusing on o

关 键 词：主动脉瓣关闭不全 心脏外科手术 主动脉瓣修复手术 二叶主动脉瓣 主动脉根部 

分 类 号：R654.2[医药卫生—外科学]