ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

17 декабря 2001 00:00 | Tirone E. David, MDa, Susan Armstrong, MSca, Joan Ivanov, MSca,

Aortic valve sparing operations: an update

^{a Division of Cardiovascular Surgery, The Toronto Hospital, University of Toronto, Toronto, Ontario, Canada
Address reprint requests to Dr David, 200 Elizabeth St, 13EN219, Toronto, ON, Canada M5G 2C4
e−mail: aats@torhosp.toronto.on.ca
Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.
Background. Aortic valve sparing operations in patients withascending aorta and/or aortic root aneurysms have been performedfor a decade in our institution. Initially only patients withnormal aortic valve leaflets had these operations, but morerecently we utilized them in patients with prolapse of a singleleaflet and in those with a bicuspid aortic valve. This articleis an update on the clinical results of these operations.}

Methods. From May 1988 to December 1997, 126 patients with ascendingaorta and/or aortic root aneurysms and aortic insufficiencyunderwent replacement of the ascending aorta with reconstructionof the aortic root and preservation of the native aortic valve.There were 85 men and 41 women, with a mean age of 54 years(range, 14 to 84). Thirty-two patients had the Marfan syndrome;17 patients had acute and 10 had chronic type A aortic dissection;23 had a transverse arch aneurysm; 26 had coronary artery disease,and 8 had mitral regurgitation. The aortic valve sparing operationconsisted of simple adjustment of the sinotubular junction in33 patients, adjustment of the sinotubular junction and replacementof one or more aortic sinuses in 60, and reimplantation of theaortic valve in a tubular Dacron (C.R. Bard, Haverhill, PA)graft in 33. Fifteen patients also had repair of aortic leafletprolapse. Only 4 patients had a bicuspid aortic valve.

Results. There were 3 operative deaths due to cardiac failure.Patients were followed from 2 to 117 months, with a mean of31. There were 11 late deaths: 7 cardiovascular and 4 from unrelatedcauses. The actuarial survival was 72 ± 8% at 7 years.Two patients required aortic valve replacement; the freedomfrom aortic valve replacement was 97 ± 2% at 7 years.Doppler echocardiography revealed absent, trivial or mild aorticinsufficiency in most patients; only 9 patients had moderateaortic insufficiency.

Conclusions. Aortic valve sparing operations are feasible inmost patients with ascending aorta and/or aortic root aneurysmswho have normal or near normal aortic leaflets. The functionalresults of the repaired aortic valve are excellent, and therepair appears to be durable.

Поделиться: