Clinical Efficacy Of Aortic Valve Repair In 43 Cases Of Aortic Regurgitation In Adult

Background:Aortic root contains the aortic leaflets,the functional aortic annulus,and the sinuses of Valsalva.Changes in the structure and function of any part of the aortic root will cause aortic regurgitation.Aortic regurgitation accounts for about 25% of heart valve diseases,and the morbidity is often higher in men than in women.Patients with aortic regurgitation can be asymptomatic for a long time.Even patients with severe regurgitation can take up to 10-20 years to the appearance of clinical symptoms.Once the symptoms of total heart failure appear,most patients will lose the opportunity of surgery.Therefore,it is very important to grasp the timing of aortic valvuloplasty.As we know,for patients with aortic regurgitation or aortic root dilatation,aortic valve replacement and replacement of aortic root by composite graft are regarded as the gold standard in surgical treatment.In 1983,Professor Yacoub proposed root remodeling technique for the first time and David and Feindel proposed reimplantation technique in1992.After that,aortic valve repair gradually developed and became one of the standardized surgical techniques.It also becomes an important part of contemporary cardiac surgery.The advantages of an aortic valve repair are:1.No complications of thromboembolism and bleeding caused by anticoagulant therapy of mechanical valve replacement.2.No reoperation caused by the structural deterioration of bioprosthesis.3.Especially for female patients who desire to become pregeant,the teratogenic effects of warfarin are avoided.4.It’s also can prevent children or minors who are developing from the risk of a reoperation.5.The repaired valve is closer to the natural state than the prosthetic valve,which is more conducive to heart function and has a higher quality of life.6.Valve repair also can avoid infective endocarditis caused by prosthetic valve.Due to the technical requirements and concerns of surgical failure,aortic valve repair is still unpopular。Objectives:Through retrospective analysis of 43 cases of aortic regurgitation to discuss the safety and efficacy of aortic valve repair.Methods:43 patients underwent aortic valve repair in our hospital from April 2016 to November 2019,including 24 males and 19 females,with an average age of 59.0±14.8 years.The patient’s preoperative NYHA functional class: 0 cases of grade I,7 cases of grade II,28 cases of grade III,and 8 cases of grade IV.The preoperative echocardiogram showed that the diameter of the left atrium(LAD)was 43.6±9.69mm; left ventricle ejection fraction(LVEF%)58.%±8.9%;left ventricular end diastolic diameter(LVEDD)53.69±5.96 mm.Aortic regurgitation(AR)classification:there were 20 cases of moderate AR,15 cases of moderate-severe AR,8 cases of severe AR before operation.Surgery was performed with general anesthesia endotracheal intubation and moderate hypothermic(core temperature:32℃)cardiopulmonary bypass.Aortic valve repair methods: 19 cases of central plication;6 cases of aortic valve leaflet calcification shaving,3 cases of commissural suture of perforation,4 cases of David,3 cases of autologous pericardial patch implantation,3 cases of Yacoub,2 cases of triangular resection,and 3 case of aortic annuloplasty.Concomitant procedures were performed in 14 patients.The operations were coronary artery bypass grafting(2 cases,14%),mitral valve repair(2 cases,14%),Graft replacement of dilated ascending aorta(9 cases,65%)and mitral valve replacement(1 case,7%).Intraoperative transesophageal echocardiography(TEE)can clarify the repair efficacy and none of all patients had more than mild AR.Results:All patients survived in hospital.They were regularly screened by transthoracic echocardiography(GE Vivid E9,USA)at one week,three months,six months,one year and annually after repair.All parameters were significantly improved compared with preoperative after one week of repair: left atrial diameter(LAD)36.61±5.43 mm,left ventricular ejection fraction(LVEF%)60%±8.0%,left ventricular end diastolic diameter(LVEDD)49.46±5.41 mm.Two cases were above the NYHA functional class II and no cases with moderate to severe regurgitation.All the results are statistically significant(P<0.05).They were followed up for 2 to 36 months without serious complications during the perioperative period.43 cases were followed up.2 cases developed severe chest tightness,suffocation and recurrence of severe aortic regurgitation 1 year later.The two patients underwent aortic valve replacement surgery.one patient was given conservative treatment due to the recurrence of moderate aortic regurgitation 6 months later and none of the other patients had more than mild aortic regurgitation.Conclusions:Using different surgical repair techniques is a safe and feasible method for the treatment of adult aortic regurgitation and the short-term follow-up results are satisfactory.But the mid to long-term results need further follow-up.