Summary
The main cause of aortic valve insufficiency is a dilatation of the sinotubular junction in patients with an ascending aortic aneurysm. Morphologically preserved aortic valve cusps represent an ideal condition for preservation and reconstruction of the aortic valve with an simultaneous replacement of the ascending aorta with a Dacron graft. This report presents the results of 140 patients, who underwent such surgery since 1993 in our institution. Indications for surgery, operative technique and different outcome parameters are discussed. Intra- and perioperative morbidity and mortality are low and quality of life excellent. Reoperation due to progressive aortic valve insufficiency was necessary in 2.1% of patients during follow-up. When compared with the standard operation (composite replacement utilizing a mechanical valve), patients with aortic valve reconstruction demonstrate similar results with regard to hospital stay and functional improvement. However, bleeding complications and thromboembolic events are significantly reduced in patients undergoing valve reconstruction. Due to these long-term results combined with excellent stress hemodynamics and improvement in LV function, aortic valve reconstruction currently represents our standard operative strategy in this patient group.
Zusammenfassung
Die Hauptursache für das Auftreten einer Aortenklappeninsuffizienz bei Aneurysmen der Aorta ascendens ist die Dilatation des sinotubulären Übergangs der Aortenwurzel. Die zumeist strukturell unveränderten Taschen der Aortenklappe bieten eine günstige Voraussetzung für rekonstruktive, klappenerhaltende Operationstechniken zum Ersatz der Aorta ascendens. In der vorliegenden Arbeit wird über die mittelfristigen Ergebnisse von 140 Patienten berichtet, die seit 1993 in unserer Institution mit einer solchen Operationstechnik operiert wurden. Indikationsstellung, operative Technik und verschiedene Methoden zur Erfassung relevanter postoperativer Daten werden vorgestellt. Bei niedriger Mortalität und Morbidität betrug die Reoperationsrate wegen progredienter Aortenklappeninsuffizienz 2,1%. Im Vergleich zur etablierten Operationsmethode von Aorta ascendens- Aneurysmen - dem Composite-Ersatz mit einer mechanischen Klappenprothese - lassen sich ähnlich gute Ergebnisse hinsichtlich der Dauer des Krankenhausaufenthalts und der Verbesserung der Leistungsfähigkeit erreichen. Vorteil der Rekonstruktion ist dabei der Verzicht auf eine lebenslange postoperative Antikoagulation mit den bekannten thrombembolischen Komplikationen und Blutungsrisiken. Wegen dieser Verbesserung, einer exzellenten Belastungshämodynamik und guter LVErholung postoperativ nach klappenerhaltendem Aortenersatz stellt in unserer Klinik ein rekonstruktives Operationsverfahren die Methode der Wahl bei diesen Patienten dar.
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Harringer, W., Kallenbach, K. & Haverich, A. Aortenklappenrekonstruktion mit Aorta-ascendens-Ersatz Indikation, Technik und Ergebnisse. Z Kardiol 90 (Suppl 6), 85–91 (2001). https://doi.org/10.1007/s003920170014
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DOI: https://doi.org/10.1007/s003920170014
Key words
- Aortic valve reconstruction
- aortic valve insufficiency
- ascending aortic aneurysm
- annuloaortic ectasia
- Marfansyndrome