摘要
目的总结我科近年来初步形成的成人主动脉瓣关闭不全手术修复技术体系及中短期随访结果。方法2013年3月至2020年5月期间我科施行主动脉瓣修复手术79例。2018年5月前多采用的简单修复技术治疗43例为A组;2018年6月开始采用组合的修复技术体系,即瓣环成形术、窦成形术、瓣叶成形术、窦管结合部成形术一体化治疗的36例为B组。对术前一般资料、合并手术、术中基本情况、术前术后即刻超声心动图结果对比,术后中短期随访结果进行分析。结果A组有2例单纯主动脉瓣修复,41例同期合并其他心内手术;B组有23例单纯主动脉瓣修复,13例同期合并其他心内手术。A组多采用交界下对合、嵴部悬吊等技术;B组多采用瓣环成形、瓣叶成形、窦管结合部成形等技术。A组多数患者术后反流减少至中度和轻度;而B组大多数患者术后反流减少至轻度。A组有7例重度反流修复无效,其中有2例修复后反流较术前加重。B组有8例修复无效,再次转机后3例继续修复满意。术后1年(或最后1次超声心动图随访)时的主动脉瓣反流情况:A组轻度15例,中度17例,重度4例;B组在1年内有2例接受了再次换瓣手术,余29例中轻度20例,中度7例,重度2例。结论成人中度和重度主动脉瓣关闭不全的患者中,采用组合瓣膜修复技术体系施行修复,近中期效果满意,长期效果有待观察。
Objective To summarize the construction of a technics system of aortic valve repair in adult patients with aortic regurgitation(AR).Methods From March 2013 to May 2020,aortic valve repair was performed in 79 patients.In which 43 cases underwent simple technics such as subcommissural annuloplasty,leaflet plication etc.Cases done before May,2018 were defined as A group,yet the other 36 cases underwent a routine repair technics system including annuloplasty,sinusplasty,cuspidplasty and sinotubularplasty after then as B group.The general data and the operation procedure,also the follow-up were analyzed.Results In group A,there were 2 cases with simple aortic valve repair and 41 cases with other intracardiac operations.In group B,23 patients had aortic valve repair alone and 13 patients had other intracardiac operations.Group A mostly adopts the technologies of subjunctional involution and ridge suspension.In group B,flap ring molding,flap leaf molding,sinus tube joint molding and other technologies were used.Postoperative reflux was reduced to moderate or mild in most patients in group A.In group B,postoperative reflux was reduced to mild in most patients.There were 7 cases of severe reflux in group A,and 2 cases of severe reflux were worse after repair than before surgery.In group B,8 patients had no effective repair,and 3 patients continued to have satisfactory repair after the second turnaround.Aortic regurgitation at 1 year(or the last echocardiographic follow-up)after surgery:15 patients in group A were mild,17 were moderate,and 4 were severe;In group B,2 patients underwent revalve replacement within 1 year,and the remaining 29 patients were moderate and mild,20 cases were moderate,7 cases were moderate,and 2 cases were severe.Conclusion In some adult moderate and severe AR cases,a routine combined repair system can be applied to increase success rate of repair,and shows a good short and mid-term result.
作者
贾一新
孟旭
焦玉清
李岩
王盛宇
韩杰
陈宗皓
Jia Yixin;Meng Xu;Jiao Yuqing;Li Yan;Wang Shengyu;Han Jie;Chen Zonghao(Department of Cardiac Surgery,Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100029,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2021年第9期546-549,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
