大動脈基部拡大に対する自己弁温存基部再建術 -―reimplantation法

Valve-sparing Replacement in Patients with Aortic Root Dilatation

大動脈基部置換術において，Bentall手術が手術成績や遠隔成績においてもっとも信頼しうる術式であることは論をまたない．しかし，人工弁にまつわる合併症を回避すべく，近年は若年者の大動脈基部病変を中心に自己弁温存の基部再建術が行われてきている．さらに以前であれば温存できなかった，弁変性のある症例に対しても各種弁形成術を併用し良好な結果が報告されてきている．当科においても術前の大動脈弁の形態や年齢を考

Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years （range, 14～69 years）. Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.