Abstract： Replacement of the aortic valve and aortic root has been the standard surgical strategy for patients with aortic root aneurysm for many years. Along with the increasing knowledge about the aortic root anatomy and physiology, and complications after aortic valve replacement, the technique of valve-sparing aortic root replacement has developed greatly. We focus on the etiology and classification aortic valve insufficiency, the valve-sparing techniques and clinical outcomes of valve-sparing aortic root replacement in this review.
Objective To analyze the incidence of valve prosthesis-patient mismatch (PPM) and ventricular remodeling of elderly patients after aortic valve replacement (AVR). Methods We retrospectively analyzed the clinical data of 134 patient aged over 65 years who underwent AVR for the aortic stenosis or regurgitation at our hospital between January 2016 and December 2016. There were 73 males and 61 females aged 69.7±3.6 years ranging from 65-79 years. The clinical and ultrasound cardiography data were evaluated. PPM was defined as an effective orifice area index (EOAI) of ≤0.85 cm2/m2. The incidence of PPM and the left ventricular remodeling after surgical AVR in the patients with aortic stenosis and aortic regurgitation was analyzed, and the outcomes of aortic valve mechanical prosthesis and aortic valve bioprosthesis were compared. Results The incidence of PPM was 32.5% in aortic stenosis and 13.0% in aortic regurgitation (P<0.05). One patient died in the early post-operation, and the incidence of severe PPM was 6.0%. Conclusion The incidence of PPM after AVR in the patients with aortic regurgitation is less than that in the patients with aortic stenosis.
Seven hundred and eighty three cases of rectal carcinoma were treated in this hospital Jan. 1986 to Dec. 1994. There were 552 cases(70.5%)in which the tumor located in the middle and lower portion of the rectum. Of this group, 201 cases were treated with the operations of preservation of sphincter ani. The operations included transabdomino-sacral resection(5 cases), transpubic resection(5 cases), Dixon’s operation(67 cases), perineal pull through anastomosis(44 cases), Welch’s operation(68 cases), and local resection(12 cases). The 3-year survival rate was 90.9%. We consider that anal sphincter preservation is rational in the treatment of rectal cancer of middle and lower segment, As often os the radical resection and maintenauce of normal defecation is concerned, it is suitable for rectal carcinomas in Duke’s A and B1 stages. Combined treatment is necessary to prevent the recurrence and increase the survival rate.
Objective To assess clinical outcomes of valve-sparing aortic root replacement for patients with aortic root aneurysm.?Methods?From February 2001 to September 2010， sixty patients with aortic root aneurysm underwent valve-sparing aortic root replacement in Fu Wai Hospital. There were 44 male patients and 16 female patients with an average age of 37.2±13.0 years （ranging from 9-64 years）. Fifteen patients had aortic dissection， 10 patients had ascendingaorta aneurysm， 25 patients had Marfan syndrome， and 2 patients had bicuspid aortic valve. Aortic root reconstruction was performed in 53 patients and aortic valve reimplantation was performed in 7 patients. Preoperative and postoperative heart function and degree of aortic insufficiency （AI） were compared.?Results?Valve-sparing aortic root replacement was performed in all patients. There was no in-hospital death or severe postoperative complications in this group. The median duration of mechanical ventilation was 13 hours （ranging from 2 to 1 110 hours） ， while the mean intensive care unit stay was 2.7±2.5 days （ranging from 1 to 18 days） . Postoperative echocardiography showed AI degree was significantly reduced in all the patients. Only three patients had moderate to severe AI， and all the other patients had none or trivial AI. All the patients were followed up for 2-122 （61.5±35.9） months. During follow-up， 4 patients were lost， 9 patients died， and the overall survival rate was 83.9% （47/56）. Two patients underwent aortic valve replacement in the 13 th and 14 th postoperative month respectively because of severe AI. Heart function of 47 patients was significantly improved compared with their preoperative heart function. Thirty-five patients （74.4%）were in New York Heart Association （NYHA） functional classⅠ， and 8 patients （17.0%） were in class II. Forty patients （85.1%）were free from moderate or severe AI.?Conclusion Valve-sparing aortic root replacement has satisfactory long-term outcomes for patients with aortic root aneurysm， and valve-related complication rate is low.
Objective To summary the clinical experiences of ventricular septal myotomymyectomy on hypertrophic obstructive cardiomyopathy(HOCM) and investigate the treatment strategies during perioperative period for better clinical results. Methods From October 1996 to June 2009, 62 patients with HOCM underwent surgical treatment. There were 41 male and 21 female, aged 668 years with mean 34.05 years. The ventricular septal myotomymyectomy operation (Morrow operation or modified Morrow operation) was performed through the aortic incision under general anesthesia and hypothermic cardiopulmonary bypass (CPB). The concomitant operations included coronary artery bypass grafting (5 cases), mitral valve replacement (12 cases), mitral valve plasty(9 cases), aortic valve replacement (4 cases), tricuspid valve plasty(2 cases) and ductus arteriosus closure (2 cases). During the perioperative period, the patients were examined by echocardiography or transesophageal echocardiograph(TEE), electrocardiogram or dynamic echocardiogram and chest radiography. Left atrial diameter，left ventricular enddiastolic [CM(159mm]diameter，left ventricular outflow tract (LVOT) pressuregradient，interventricular septal thickness, ejection fraction[CM)](EF), the changes of mitral valve construction and function were evaluated. Results The time of CPB and aortic occlusion were 104.23±47.14 min and 66.76±36.32 min, respectively. The endotracheal intubation time was 13.23±11.76 h and the postoperative intensive care unit(ICU) stay was 42.53±37.41 h. Four patients died and the mortality was 6.45％(4/62). The main causes of death included septic shock complicated with acute renal failure(1 case), refractory arrhythmia, ventricular fibrillation, atrial flutter complicated with severe low cardiac output syndrome (1 case), severe acute renal failure(1 case) and Ⅲ°atrioventricular(AV) block complicated with low cardiac output syndrome(1 case). Postoperative left atrial diameter (34.56±6.45 mm vs.43.46±7.21 mm，t=6.948,P=0.000), left ventricular enddiastolic diameter (37.14±6.31 mm vs.42.03±6.23 mm，t=3.145,P=0.020), LVOT pressure gradient (23.54±17.78 mm Hg vs. 103.84±44.04 mm Hg,t=13.618,P=0.000) and interventricular septal thickness (17.12±5.67 mm vs.26.93±5.23 mm, t=10.694,P=0.000) decreased significantly compared with those before operation. There was no mitral valve regurgitation, or only mild mitral valve regurgitation. No systolic anterior motion(SAM) was found. The main postoperative arrhythmias included complete left bundle branch block, intraventricular block, complete atrioventricular block and atrial fibrillation. All the 58 cases were cured and discharged. Fiftythree cases were followed up for 3 months12 years, and 5 cases were lost. No death, complication and reoperation were found. Symptoms relieved significantly. The cardiac function was in New York Heart Association grade Ⅰ-Ⅱ. The quality of life improved significantly. Conclusion Most patients with HOCM can achieve satisfactory relief of LVOT obstruction and SAM via ventricular septal myotomymyectomy. The main arrhythmias after operation are bundle branch block and atrial fibrillation. Satisfactory effects can be achieved by accurate surgical technique and effective drug treatments.