リモデリング法と大動脈弁輪形成術を用いた弁温存大動脈基部置換術の標準化

Standardization of Valve-sparing Aortic Root Replacement Operation Using Aortic Root Remodeling Procedure Combined with External Suture Annuloplasty

大動脈弁閉鎖不全症（AR）の自然予後は以前はそれほどわるくないと見積もられていたが，近年の綿密な追跡研究によると年間死亡率は2.2％にも及ぶと報告されている1）．大動脈弁置換術（AVR）を受けると正常人と同様の予後が見込めること，以前推測されていたよりも小さな左室径でも予後が悪化することなどが判明したことより，従来のガイドラインの推奨よりも早期での手術が提唱されつつある1）．

The natural prognosis of patients with aortic regurgitation （AR） has proved to be poorer than one might expect, thus surgical intervention should be recommended earlier than before. The most of patients with AR are relatively younger and therefore may benefit from aortic valvuloplasty （AVP） to eliminate prosthesis-related late adverse events. However, AVP does not seem popular enough because long-term durability after AVP is still unclear. For this purpose, long-term outcomes after AVP should be improved by standardizing the procedure, especially using aortic root remodeling procedure combined with external suture annuloplasty. The detail of the standardization of these procedures is outlined in this review briefly. We hope more and more aortic valves of the patients with not only aortic root dilatation but also isolated AR will be preserved based on this review in the near future.