首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 24 毫秒
1.
Results of aortic valve-sparing operations.   总被引:3,自引:0,他引:3  
OBJECTIVE: To review the late results of valve-sparing operations in patients with aortic root aneurysm and in those with ascending aortic aneurysm and aortic insufficiency. METHODS: From May 1988 to June 2000, 120 patients with aortic root aneurysm and 68 with ascending aortic aneurysm and aortic insufficiency underwent aortic valve-sparing operations. Patients with aortic root aneurysm were younger, were predominantly male, and had less severe aortic insufficiency than patients with ascending aortic aneurysm, who were older and often had aneurysm of the transverse arch. Forty-eight patients with aortic root aneurysm had the Marfan syndrome. The prevalence of aortic dissection was similar in both groups. Reconstruction of the aortic root was performed by reimplanation of the aortic valve in 64 patients and by remodeling of the aortic root in 56. Patients with ascending aortic aneurysm and aortic insufficiency were treated by replacement of the ascending aorta with reduction in the diameter of the sinotubular junction. Approximately two thirds of the latter patients also required replacement of the transverse aortic arch. The mean follow-up was 35 +/- 31 months for patients with aortic root aneurysm and 26 +/- 23 months for those with ascending aortic aneurysm. RESULTS: There were 2 operative and 5 late deaths in patients with aortic root aneurysm and 1 operative and 9 late deaths in patients with ascending aortic aneurysm. The 5-year survival for patients with aortic root aneurysm was 88% +/- 4% and for patients with ascending aortic aneurysm, 68% +/- 12% (P =.01). Severe aortic insufficiency developed in 2 patients, and they required aortic valve reoperation. The 5-year freedom from aortic valve reoperation was 99% +/- 1% for patients with aortic root aneurysm and 97% +/- 4% for those with ascending aortic aneurysm. Seven patients had moderate aortic insufficiency at the latest echocardiographic study. The 5-year freedom from severe or moderate aortic insufficiency was 90% +/- 4% in patients who had aortic root aneurysm and 98% +/- 2% in those who had ascending aortic aneurysm. CONCLUSIONS: Aortic valve-sparing operations have provided excellent clinical outcomes and few valve-related complications. The function of the reconstructed aortic root remains unchanged in most patients during the first 5 years of follow-up.  相似文献   

2.
Aortic valve-sparing operations for aortic root aneurysm   总被引:1,自引:0,他引:1  
The object of this report is to review the clinical outcomes of aortic valve-sparing operations in patients with aortic root aneurysm. From May 1988 to June 2000, 120 patients with aortic root aneurysm with or without aortic insufficiency underwent aortic valve-sparing operations. There were 83 men and 37 women whose mean age was 46 years (range 16 to 72 years). Forty-eight patients had the Marfan syndrome, and 22 had either acute or chronic type A aortic dissections. Reconstruction of the aortic root was performed using the technique of reimplanation of the aortic valve in 64 patients and the remodeling of the aortic root in 56. The mean follow-up was 35 months (range 2 to 145 months), and it was complete. Aortic valve function was assessed by echocardiography. There were 2 operative and 5 late deaths. The 10-year survival for patients with aortic root aneurysm was 88% +/- 4%. Two patients have required aortic root replacement: one on the first postoperative day because of severe aortic insufficiency and one paraplegic patient 12 years after surgery because of infective endocarditis with aortic root abscess. Both patients survived reoperation. The 10-year freedom from aortic root reoperation was 99% +/- 1%. Three patients suffered transient ischemic attacks. The 10-year freedom from thromboembolic events was 89% +/- 5%. Seven patients had moderate aortic insufficiency at the latest echocardiographic study. The 10-year freedom from severe or moderate aortic insufficiency was 83% +/- 8%. Aortic valve-sparing operations have provided excellent clinical outcomes and few valve-related complications. The function of the reconstructed aortic root remains unchanged in most patients during the first decade of follow-up.  相似文献   

3.
Objective: We sought to determine, by a mathematical model, the ideal theoretical degree of ascending aortic graft oversizing needed to obtain normal sinuses dimension in the reimplantation type of valve-sparing aortic operations. Methods: To define a normal-range value, size of sinuses of Valsalva was conventionally expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area (BLA), and measured in 50 healthy subjects. A mathematical relationship between aortic annulus diameter, aortic sinuses diameter and resulting BLA was defined. By simulating intra-operative scenarios, the effect of different degrees of a standard or Valsalva graft oversizing on BLA extension was tested. Results: The same degree of graft oversizing resulted in a bigger beyond leaflets area for the Valsalva graft than for a standard graft. Oversizing degrees exceeding +7 mm for a standard graft and +3 mm for the Valsalva graft resulted in a beyond leaflets area over normal limits. Results were expressed in a visual form as two different normograms, one for the standard graft and one for the Valsalva graft. Conclusions: A less pronounced graft oversizing is needed to achieve normal-range sinuses size when using a Valsalva graft, the ideal theoretical graft oversizing was +7 mm for a standard graft and +3 mm for the Valsalva graft, our normograms can be helpful in selecting a proper graft size when performing a valve-sparing aortic procedure.  相似文献   

4.
5.
6.
7.
Simple and reproducible methods for accurate restoration of aortic root dimensions during aortic valve-sparing operations are described. The methods are based on choice of an appropriate size vascular graft based on the measured or desired diameter of the aortic annulus.  相似文献   

8.
Plastic operations were carried out on 50 patients with rheumatic aortic valvular diseases. Not only the aortic but also the mitral valve was corrected in 37 patients, 9 patients underwent interventions on three valves. Hospital lethality was 8%. Intraoperative measurement of hemodynamics showed adequate correction of the aortic valvular defect in most patients. The late-term results were studied in follow-up periods of 6 to 34 months. Five patients died from early septic secondary endocarditis, the cause of death in 2 cases was not identified. The results of functional methods of examination showed that the aortic valve functioned well in the other cases.  相似文献   

9.
10.
11.
目的 初步总结带Valsalva窦人工血管在保留主动脉瓣的主动脉根部替换术(David Ⅰ术)中的临床应用效果.方法 2008年1月至2011年5月,在David Ⅰ术式中应用带Valsalva窦人工血管治疗主动脉根部病变致主动脉瓣关闭不全(AI)15例.男14例,女1例;年龄33~67岁,平均(49.5±10.3)岁.术前心功能Ⅰ级11例,Ⅱ级4例;主动脉瓣反流中度9例,重度6例.同期手术包括主动脉弓置换9例,冠状动脉旁路移植(CABG)术4例,二尖瓣与三尖瓣成形1例,房间隔缺损(ASD)修补术1例.结果 围术期死亡2例,分别死于肺部感染和血源性感染性休克合并多脏器功能衰竭.全组平均体外循环(230.0±54.4) min,平均主动脉阻断(181.2±30.6) min.术后1周复查心功能均为Ⅰ级,主动脉瓣反流轻度6例,轻至中度1例,8例无反流.出院随访3~24个月,平均(8.8±5.9)个月.无主动脉瓣反流3例,轻度9例(3例6个月后复查转为无反流),中度1例(3个月后复查转为轻度).结论 David Ⅰ术式中应用带Valsalva窦人工血管治疗主动脉瓣叶及瓣环大致正常的主动脉根部病变是一种可选择的手术方案,早期手术效果良好,中、远期效果需进一步随访观察.  相似文献   

12.
David TE  Ivanov J  Armstrong S  Feindel CM  Webb GD 《The Annals of thoracic surgery》2002,74(5):S1758-61; discussion S1792-9
BACKGROUND: Aortic valve-sparing operations are an alternative to aortic root replacement in patients with aortic root aneurysms, or aortic valve replacement and supracoronary replacement of the ascending aorta in patients with ascending aorta aneurysms and dilated sinotubular junctions with consequent aortic insufficiency. METHODS: From 1988 to 2001, 230 patients underwent aortic valve-sparing operations for aortic root aneurysms (151 patients) or ascending aortic aneurysms with aortic insufficiency (79 patients). Two types of aortic valve-sparing operations were performed in patients with aortic root aneurysms: reimplantation of the aortic valve and remodeling of the aortic root. Mean follow-up was 3.8 +/- 2.8 years. RESULTS: Patients with aortic root aneurysms were younger, had less severe aortic insufficiency, less extensive vascular disease, and better left ventricular function than patients with ascending aorta aneurysms. The 8-year survival was 83% +/- 5% for the first group and 36% +/- 14% for the second. The freedom from aortic valve reoperation at 8 years was 99% +/- 1% for the first group and 97% +/- 2% for the second. In patients who had aortic root aneurysms, 3 developed severe aortic insufficiency (AI), and 15 developed moderate AI, for an 8-year freedom from significant AI of 67% +/- 7%. But freedom from AI was 90% +/- 3% after the technique of reimplantation, and 55% +/- 6% after the technique of remodeling (p = 0.02). In patients with ascending aortic aneurysms, the freedom from AI greater than 2+ at 8 years was 67% +/- 11%. CONCLUSIONS: The long-term results of aortic valve sparing for aortic root aneurysms are excellent, and reimplantation of the aortic valve may provide a more stable repair of the aortic valve than remodeling of the aortic root.  相似文献   

13.
14.
OBJECTIVE: The aim of the present study was to define a method to pre-determine the correct size of neo-sinuses of Valsalva in the reimplantation type of valve-sparing aortic operation. METHODS: The objective was achieved in three steps: (1) evaluation in the healthy population, of the normal size of sinuses of Valsalva expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area; (2) elaboration of a normogram by which, given a known annular diameter, it is possible to select the appropriate graft size to obtain a normal beyond leaflets area; (3) validation of the normogram by comparing, in a population of 20 patients undergoing a valve-sparing procedure, the predicted and observed beyond leaflets area. RESULTS: The following values for beyond leaflets area were observed: mean normal 320.6+/-120.6mm(2), mean predicted 355+/-63.2mm(2), mean observed 364.7+/-72.8mm(2).No significant differences were obtained for predicted versus observed values. Regression analysis showed a linear distribution with an r value of 0.95. CONCLUSIONS: We proposed a simplified approach for sizing of the neo-aortic root in the reimplantation type of valve-sparing aortic operation focussed on the size of sinuses of Valsalva. Our normogram showed to be reliable in anticipating beyond leaflets area. It can be helpful in avoiding the selection of an undersized or excessively oversized graft.  相似文献   

15.
16.

Background

Valve-sparing operations for aortic root aneurysms are increasing in frequency, but techniques and results are still in evolution. We reviewed our experience with 65 patients (adults and children) who had this operation at our institution to determine early and late outcomes.

Methods

A retrospective clinical review was undertaken using hospital records, clinical and echocardiographic, computed tomography, magnetic resonance imaging data, and telephone interviews with patients and their physicians.

Results

Between July 1994 and December 2002, 65 patients (46 adults and 19 children) underwent a valve-sparing operation for aortic root aneurysm. Forty-four of the patients had the Marfan syndrome; the remaining 21 had either a nonspecific connective tissue disorder (14 patients) or a miscellaneous disease process such as Ehlers-Danlos syndrome (7 patients). Fifty-eight (89%) had a David II (remodeling) procedure and 7 had a David I (reimplantation) procedure. The DePaulis “Valsalva graft” was used in six of the David I patients. There were no operative or hospital deaths; only one late death occurred in an adult due to salmonella meningitis. Overall, survival was 100% at one year and 98% at 3 and 5 years. Ten patients (7 adults and 3 children) developed significant late aortic insufficiency (AI). Nine of these patients had a David II procedure and in 8 of these cases, AI was secondary to significant late annular dilatation. One of the 10 patients developed late AI 8.2 years after a David I procedure; his AI was secondary to aortic leaflet extension and prolapse. Six of the 10 patients who developed significant late AI required aortic valve replacement (4 adults and 2 children). Freedom from late aortic valve replacement (AVR) in this series of 65 patients was 91% at 3 and 84% at 5 years. At the close of this study, 58 patients were New York Heart Association (NYHA) class I and 6 were NYHA class II; no patients were class III or IV. There were no episodes of endocarditis or clinically significant thromboembolism.

Conclusions

Valve-sparing operations provide satisfactory results for many patients with an aortic root aneurysm, but the David II remodeling procedure has a greater risk of late annular dilatation and AI. The David I reimplantation procedure utilizing the DePaulis Valsalva graft may obviate this problem.  相似文献   

17.
18.
Our goal was to understand why it is difficult to achieve reliable valve competence after aortic valve-sparing surgery, and to propose quantitative data aimed at improving the outcome of the procedure. Valve-sparing procedures were performed in patients with dilated aortic roots and aortic regurgitation, and reproduced in physical models to explore what should be the restored dimensions of the aortic root and leaflets for valve sparing to be successful. In parallel, a three-dimensional geometric model of the aortic valve was tested to evaluate its capability to predict the annulus diameter, sinotubular junction diameter, valve height, and leaflet free-edge length and height in competent spared valves. Valve sparing resulted in more or less severe residual regurgitation in all the patients considered. Successful valve-sparing was achieved in vitro by making further changes to the annulus diameter, the leaflet free-edge length and/or graft size. The changes needed were effectively predicted by the geometric model. Tabulated valve dimensions allowing restoration of competence were generated for convenient use by surgeons. A quantitative approach to aortic valve sparing is proposed, putting emphasis on the functional characteristics of the restored valve geometry.  相似文献   

19.
OBJECTIVES: We have conducted aortic valve-sparing operation for patients having aortic root dilatation and almost normal aortic valve leaflets since August 1998, and here report midterm results. METHODS: Patients with dilated aortic annulus or Marfan's syndrome were treated with reimplantation, and the remaining patients with remodeling. Either 24 or 26 mm graft was selected based on aortic annular diameter and leaflet size. Aortic valve competence was assessed regularly with echocardiography. RESULTS: Five patients (age: 29 +/- 13 yr), including 4 with Marfan's syndrome, had undergone reimplantation, and 3 (age: 46 +/- 18 yr) remodeling by December 2000. Mean follow-up was 18 (range: 10-32) months, and no postoperative death has occurred and no reintervention has been required thus far. All the patients in the remodeling group showed only a small pressure gradient through the aortic valve and decreased left ventricular diameter. Two in the reimplantation group showed a pressure gradient exceeding 20 mmHg. Two Marfan's syndrome patients in the reimplantation group showed slightly increased diastolic left ventricular diameter and 3 slightly increased systolic left ventricular diameter. Although aortic regurgitation had diminished in all patients by discharge, moderate aortic regurgitation recurred in 1 non-Marfan's syndrome patient in the reimplantation group because of degenerated aortic valve. CONCLUSION: Although postoperative aortic valve function was not perfect in all patients undergoing reimplantation, midterm results after aortic valve-sparing operation were generally satisfactory. Proper selection of patients, procedures, and graft size was thought to be important to ensure a favorable surgical outcome.  相似文献   

20.
设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号