Evaluation of valve-sparing aortic root reimplantation procedure in 24 patients with aortic valve insufficiency due to aortic root disease
10.3760/cma.j.issn.1001-4497.2012.12.004
- VernacularTitle:David Ⅰ手术治疗主动脉根部病变致主动脉瓣关闭不全的效果
- Author:
Bin YOU
;
Ping LI
;
Feng GAO
;
Yi XU
;
Lili XU
;
Shuo LIU
- Publication Type:Journal Article
- Keywords:
Aortic diseases;
Aortic valve insufficiency;
Vasalva conduit;
David Ⅰ procedure
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2012;(12):716-720
- CountryChina
- Language:Chinese
-
Abstract:
Objective To observe the clinical results of the valve-sparing root reimplantation procedure(David Ⅰ procedure) in patients with aortic valve insufficiency due to aortic root disease.Methods From august 2005 to May 2011,aortic valve-sparing root reimplantation was performed in 24 patients with aortic insufficiency due to aortic root disease,21 males and 3 females; mean age (47.0 ± 12.3) years old (from 24years to 69years) ; 20 being of heart functional class Ⅰ,3 of class Ⅱ,and 1 of class Ⅲ; 13 with moderate and 11 with severe aortic insufficiency ; The tubular graft was used in 9 patients and valsalva conduit was used in15 patients in David Ⅰ procedure.Concomitant procedures included 6 CABG operations,11 aortic arch replacement operations,1 mitral annuloplasty and tricuspid annuloplasty,1 VSD repair and 1 ASD repair operation.Conversion to Bentall procedure was necessary in only one patient because transesophageal echocardiography (TEE) showed moderate aortic insufficiency due to aortic valve prolapse.Post-operative aortic valve regurgitation and heart function were followed up.Results There were two peri-operative deathes(one died of pulmonary infection in the 22th day postopertatively,another one died of haemategenous septic shock and multiple organ failure in the 9th day postopertatively),one late death other than operation-related reasons(died of pulmonary infection in the 54th day postopertatively).The mean extracorporeal circulation time was (235.9 ± 58.5) min,the aortic crossclamp time was(182.7 ± 35.8) min.11 patients had no aortic regurgitation,11 gentle and 1 moderate regurgitation postopertatively ; The heart functional of all patients changed into class Ⅰ one week post-operatively.20 patients were followed-up 3 to 74 months,of which 3 with no and 15 with gentle (3 of which showed no aortic regurgitation in half year later) and 2 with moderate aortic regurgitation (1 patient with Marfan syndrome used tubular graft showed severe postopertative aortic regurgitation 55 months later).Conclusion David Ⅰ procedure is a good option for patients with aortic valve insufficiency due to aortic root disease,and with more or less normal aortic leaflets and valvular ring normal.Furthermore using Valsalva conduit in David Ⅰ procedure could provide a more stable mid and long-term effect.
