French cuff techniqueによるBentall手術の成績

Outcomes of Modified Bentall Procedure with French Cuff Technique

大動脈弁疾患・弁輪拡張症を伴った大動脈基部病変に対しては，弁形成術が可能であれば，良好な長期生存率や低い遠隔期脳血管イベントが見込まれる自己弁温存基部置換術であるremodeling法やreimplantation法が行われるのが，現在の主流である1）．しかしながら，弁形成術が困難な肥厚短縮などの弁変性のある症例，特に高齢の症例では弁変性が進行しており，弁置換術を併施した大動脈基部置換術が必要とされる．そのため，弁付きコンポジットグラフトによるBentall手術は高齢社会でいまだ需要のある手技であると考える．Bentall手術の手技で一番に重要なポイントは，いかに基部置換部位から出血させず，遠隔期に仮性瘤などを形成させないかであるといえ，miniskirt technique2），French cuff technique3），refined flanged technique4）など数種類の方法が考案され，良好な成績が報告されている．

Background：We evaluated early and mid-term outcomes of modified Bentall procedure with French cuff technique for aortic root disease.

Methods：Between 2017 and 2024, 45 patients underwent modified Bentall procedure with French cuff technique. We excluded patients who had cardiopulmonary resuscitation. The mean age was 64.8±14.0 years, and 35 patients were male （77.8％）. The mean predicted operative mortality rate according to JapanSCORE 2 was 11.2％.

Results：No patients had any trouble with bleeding from the aortic root. Hospital mortality was 2.2％, as one patient died due to a fungal infection. Twelve patients （26.7％） experienced complications during hospitalization. The 3- and 5-year overall survival rates were 97.7％ and 88.0％, respectively. Freedom from reoperation was 93.7％ and 93.7％ at 3 and 5 years, respectively. One patient underwent re-aortic valve replacement due to a stuck valve, and one underwent re-Bentall due to a seroma. There were no pseudoaneurysm formations of the aortic root and coronary ostia during the followed-up.

Conclusions：The modified Bentall procedure with French cuff technique may be a useful technique with good outcomes.