The Japanese Journal of Thoracic Surgery Volume 71, Issue 1 （January 2018）

胸部外科 71巻1号（2018年1月発行）

Japanese English

特集進化した大動脈基部置換術

大動脈基部置換術の現状と治療成績 -―手術手技の工夫と自己弁温存手術後の基部geometry解析 Surgical Results of Aortic Root Replacement；Technical Modification and Geometric Analysis of Aortic Root after Aortic Valve-sparing Procedure 内田徹郎 ¹ , 浜崎安純 ¹ , 黒田吉則 ¹ , 水本雅弘 ¹ , 山下淳 ¹ , 林潤 ¹ , 廣岡秀人 ¹ , 石澤愛 ¹ , 赤羽根健太郎 ¹ , 貞弘光章 ¹ Tetsuro Uchida ¹ , Azumi Hamasaki ¹ , Yoshinori Kuroda ¹ , Masahiro Mizumoto ¹ , Atsushi Yamashita ¹ , Jun Hayashi ¹ , Shuto Hirooka ¹ , Ai Ishizawa ¹ , Kentaro Akabane ¹ , Mitsuaki Sadahiro ¹ ¹山形大学外科学第二講座 ¹Second Department of Surgery, Yamagata University Faculty of Medicine キーワード：大動脈基部置換術 , 自己弁温存手術 Keyword: aortic root replacement , valve-sparing aortic root reconstruction pp.12-18

発行日 2018年1月1日 Published Date 2018/1/1

DOI https://doi.org/10.15106/j_kyobu71_12

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参考文献 Reference

大動脈基部置換術は，従来コンポジットグラフトによるBentall手術が標準術式であったが，最近では自己弁温存手術が大動脈弁輪拡張症（AAE）/大動脈弁閉鎖不全症（AR）のみならず，急性大動脈解離の緊急手術にまで適応を拡大している．これまで当科では，手術手技の標準化による自己弁温存手術の再現性確立をめざしてきた1）．本稿では，われわれの自己弁温存手術症例の手術成績と基部geometry解析によるAR

Background：The Bentall procedure is a reliable treatment of various types of aortic root pathology. Furthermore, the aortic valve-sparing aortic root replacement also has been accepted as an ideal procedure especially in young patients. Recently, we have developed a simple valve-sparing operation focused on standardization and reproducibility.

Methods：From 2011 to 2017, 44 consecutive patients underwent aortic root replacement （Bentall 17, David 27）in our institution. Surgical results of these patients were evaluated retrospectively. Geometric parameters of reconstructed aortic root were analyzed to evaluate aortic valve function.

Results：There were 2 operative death （Bentall 2, David 0）. Valve-sparing procedure was completed without conversion to valve replacement and no significant aortic insufficiency was noted soon after the operation. Patients underwent David operation were divided into 2 groups according to the annular diameter. There were 15 patients with large annulus and 12 with small annulus. The postoperative valve function was reproduced in both large and small annulus groups. From the results of geometric analysis of the aortic root, patients with large annulus and sino-tubular （ST） junction were anatomically more suitable and better treated with reimplantation technique. On the other hand, even in patients with small annulus, effective plication of ST junction and adequate suspension of commissure posts might be contribute to restore the valve competency with reimplantation technique. Two patients had aortic valve replacement 6 and 12 months after reimplantation, respectively.

Conclusions：The acceptable outcome was demonstrated in patients underwent aortic root replacement. Aortic valve was reproduced well with our simple modification of valve-sparing operation. Although our modified technique is considered to be safe, reproducible and technically less demanding, close observation would be mandatory in this particular circumstance.