主动脉瓣-二尖瓣瓣环扩大手术在再次瓣膜手术中应用的单中心回顾性研究

Aortic-mitral annular enlargement technique in re-valve surgery:A retrospective study in a single center

目的探讨及评估主动脉瓣-二尖瓣瓣环扩大手术(双瓣环扩大手术)在既往置换较小型号瓣膜患者再次手术中的安全性、有效性。方法回顾性分析2020年4月—2022年4月武汉亚洲心脏病医院行双瓣环扩大手术再次手术患者的临床资料。结果纳入30例患者,其中男2例、女28例,年龄9~78(52.71±3.53)岁。所有患者均曾行心脏瓣膜手术,其中有1例患者行第3次心脏手术。所有患者均手术成功,无院内死亡。无术后出血需二次开胸止血患者,1例患者因术后出现病窦综合征行永久起搏器植入。植入的人工主动脉瓣瓣环平均直径(24.23±1.60)mm,较术前[(21.03±1.90)mm]明显增大(P<0.001)。植入的人工二尖瓣瓣环平均直径(28.33±1.21)mm,较术前[(25.43±0.84)mm]明显增大(P<0.001)。术后超声心动图显示人工主动脉瓣平均峰值跨瓣压差(18.17±6.44)mm Hg,较术前[(82.57±24.48)mm Hg]显著降低(P<0.001)。术后人工二尖瓣平均峰值跨瓣压差(12.73±5.45)mm Hg,较术前[(19.43±8.97)mm Hg]明显降低(P=0.003)。结论双瓣环扩大手术应用于既往置换较小型号瓣膜患者再次手术安全、有效,不仅获得了较大尺寸的人工瓣膜植入,以获得更大的瓣口面积,还可以保证二尖瓣-主动脉瓣联合体的稳定性,从而具有良好的血流动力学特征和临床效果。

Objective To investigate and evaluate the safety and efficacy of the aortic-mitral annular enlargement technique(double annular enlargement)in patients with small-size valve prostheses after prior valve surgery.Methods The clinical data of patients who underwent double valve annular enlargement in Wuhan Asia Heart Hospital from April 2020 to April 2022 were retrospectively analyzed.Results A total of 30 patients were collected,including 2 males and 28 females aged 9-78(52.71±3.53)years.All patients had previous heart valve surgery,including 1 patient receiving the third heart surgery.All patients were operated on successfully and there were no postoperative in-hospital deaths.There was no postoperative bleeding which needed a secondary open-chest hemostasis,and one patient underwent permanent pacemaker implantation due to postoperative sick sinus syndrome.The mean diameter of the implanted prosthetic aortic valve was 24.23±1.60 mm,which was significantly larger than that of the preoperative aortic valve(21.03±1.90 mm,P<0.001).The mean diameter of the implanted prosthetic mitral valve was 28.33±1.21 mm,which was significantly larger than that of the preoperative mitral valve(25.43±0.84 mm,P<0.001).The mean peak gradient difference across the prosthetic aortic valve on postoperative echocardiography was 18.17±6.44 mm Hg,which was significantly lower than that of the preoperative aortic valve(82.57±24.48 mm Hg,P<0.001).The mean peak gradient difference of the postoperative prosthetic mitral valve was 12.73±5.45 mm Hg,which was significantly lower than that of the preoperative mitral valve(19.43±8.97 mm Hg,P=0.003).Conclusion The double annular enlargement technique is safe and effective for reoperation in patients with a history of valve surgery with a small aortic root to obtain both a larger size prosthetic valve for a larger orifice area and stability of the mitral-aortic valve union,resulting in good postoperative hemodynamic characteristics and clinical outcomes.