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The Japanese Journal of Thoracic Surgery Volume 77, Issue 7 （July 2024）

胸部外科 77巻7号（2024年7月発行）

Japanese English

特集新たな時代の大動脈基部置換術

65歳以上を対象とした生体弁大動脈基部置換術 Bio-Bentall Procedure in Patients Over 65 Years of Age 飯田泰功 ¹ , 市ノ川隆久 ¹ , 黒尾健人 ¹ , 稲葉佑 ¹ , 蜂谷貴 ¹ , 志水秀行 ² Yasunori Iida ¹ , Takahisa Ichinokawa ¹ , Kento Kuroo ¹ , Yu Inaba ¹ , Takashi Hachiya ¹ , Hideyuki Shimizu ² ¹済生会横浜市東部病院心臓血管外科 ²慶應義塾大学心臓血管外科 ¹Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital キーワード：生体弁大動脈基部置換術 , 大動脈弁輪拡張症 , valve-in-valve経カテーテル的大動脈弁置換術 Keyword: bio-Bentall procedure , annuloaortic enlargement , valve-in-valve transcatheter aortic valve replacement （TAVR） pp.491-495

発行日 2024年7月1日 Published Date 2024/7/1

DOI https://doi.org/10.15106/j_kyobu77_491

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参考文献 Reference

1968年にBentallらがStarr弁とテフロングラフトを組み合わせて弁付き導管を作成し，最初に大動脈基部置換術を行った1）．問題点として，冠状動脈吻合部からの出血や吻合部離開による仮性動脈瘤形成などがあったが，modified Bentall手術をはじめさまざまな冠状動脈再建法が行われてからは成績が大幅に安定した．その後，現在まで広く普及し，自己弁温存大動脈基部置換術（valve sparing root replacement：VSRR）が行われるようになった昨今でも，大動脈基部病変に対する標準術式である．VSRRの標準化がすすみ，成績が向上する一方，近年の生体弁の耐久性を考慮して，高齢者では生体弁大動脈弁基部置換術（bio-Bentall手術）も広く行われている．

Objective：This study aimed to review the results of the bio-Bentall procedure in patients over 65 years of age at our hospital.

Materials and Methods：Of the 65 aortic root replacement procedures performed at our hospital from October 2015 to January 2024, we reviewed 45 bio-Bentall procedures performed on patients 65 years of age or older. These patients consisted of 39 men and 6 women, with a mean age of 72 years. There were 5 patients with aortic dissection and 40 patients with non-dissection, and 6 patients had reoperation. There were 19 concomitant surgeries, including coronary artery bypass grafting, valve surgery, and aortic procedure. The bioprosthetic valves used were Magna EASE in 17 patients, Inspiris in 25 patients, Trifecta in 2 patients, and Avalus in 1 patient. All Valsalva grafts used were J Graft Valsalva.

Results：The mean intubation time was 19 hours, and the mean intensive care unit （ICU） stay was 6 days. The number of in-hospital deaths was 3 patients, and the mean length of hospital stay was 18 days. The remote mortality rate was 4 （1 heart failure, 2 lung cancer, and 1 pancreatic cancer）. There have been no case of reoperation, structural valve deterioration （SVD）, or thromboembolism to date, and the rates of freedom of reoperation, SVD, and thromboembolism were all 100％. The 1-, 3-, 5-, and 7-year survival rates were 91.1％, 86.4％, 83.6％, and 83.6％, respectively.

Conclusion：The surgical and long-term outcomes of the bio-Bentall procedure in patients over 65 years of age were stable. In patients who may outlive the bioprosthetic valve life, it is important to perform an appropriate and durable Bentall procedure, including valve-in-valve, prioritizing the future of each patient.