主动脉瓣二叶畸形外科修复技术体系的临床疗效分析

The clinical effect of a combined technical system for bicuspid aortic valves repair

目的探索主动脉瓣二叶畸形(bicuspid aortic valve,BAV)修复技术体系的初步临床效果。方法纳入2019年10月—2021年1月于首都医科大学附属北京安贞医院行主动脉瓣修复手术的BAV患者。根据解剖部位病变特点,选择性组合采用瓣环成形术、窦成形术、瓣叶成形术和窦管结合部(sinus-tubular junction,STJ)成形术。分析患者的临床资料。结果共纳入17例患者,其中男11例、女6例,平均年龄18~49(32.4±13.6)岁。Sievers分型Ⅰ型15例,Ⅱ型2例。采用瓣环成形术13例次、窦成形术8例次、瓣叶成形术17例次和STJ成形术11例次。体外循环时间95(84,135)min,主动脉阻断时间68(57,112)min,住ICU时间17(12,25)h。17例患者术后即刻超声提示,14例转为轻度,1例为中度,2例为重度;3例中度和重度反流患者二次转机行再修复,术后1例轻度反流,2例中度反流。平均随访时间(13.1±4.6)个月,最后一次超声随访时主动脉瓣轻度反流12例,中度反流5例,无再次手术。结论BAV修复组合技术体系总体可靠、安全,近中期随访效果良好。

Objective To summarize the clinical result of a combined technical system for bicuspid aortic valve(BAV)repair.Methods Patients who diagnosed as BAV and sever aortic regurgitation(AR)underwent a strategy of combined repair technics including annuloplasty,sinus plasty,leaflet plasty,sinus-tubular junction(STJ)plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled.The clinical data of the patients were analyzed.Results A total of 17 patients were enrolled.There were 11 males and 6 females with an average age of 18-49(32.4±13.6)years.Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification.Annuloplasty was applicated in 13 patients,sinus plasty in 8 patients,leaflet plasty in 17 patients,and STJ plasty in 11 patients,respectively.The cardiopulmonary bypass(CPB)time was 95(84,135)min,aortic cross-clamping time was 68(57,112)min,and the ICU stay time was 17(12,25)h.After the operation,mild AR was presented in 14 patients,moderate AR in 1 patient and severe AR in 2 patients.The latter 3 patients underwent second operation under CPB,after then,1 patient had mild AR and 2 patients had moderate AR.The follow-up time was 13.1±4.6 months.At the latest follow-up,12 patients had mild AR and 5 patients had moderate AR,and no patient had reoperation.Conclusion A combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.