大動脈基部拡張症に対する外科治療 -―大動脈基部および大動脈弁の特徴と長期経過からみた手術術式の妥当性

Aortic Root Replacement for Patients with Aortic Root Aneurysms；Clinical Outcomes Compared Among Different Types of Abnormality and Operative Procedures

大動脈基部再建術は，1968年にBentallとDe Bonoが，valved composite graftを作成しはじめて大動脈基部置換を行い1），その後，現在にいたるまで広く普及した手術術式である．問題点として，冠状動脈再建部からの出血や仮性動脈瘤があったが，modified Bentall法が行われるなど出血に対するいろいろな工夫が行われ，現在の安定した良好な手術成績が得られるようになった

Aortic root operations are established procedures for patients with aortic root aneurysms, however there is a little insight for comparative long-term outcomes among different types of anatomical abnormalities and procedures. In this study, we sought to compare the results of patients with aortic abnormalities undergoing different procedures. From January 2008 to March 2017, a total of 105 patients without aortic dissection were performed the elective aortic root surgery. Patients with bicuspid aortic valve had enlarged annulus, and those with Marfan syndrome had enlarged Valsalva without enlarged annulus. Bentall operation with mechanical valve or bioprothetic valve was performed for patients with enlarged annulus and/or abnormal aortic cusp, and David operations for patients with normal cusps. This comparative study showed that these different procedures according to our policy were associated with reduced cardiac mortality and valve-related complications. The results suggest David procedure is the treatment of choice for young patients with aortic root aneurysm and normal aortic cusps, however, careful patient selection is paramount.