Autologous pericardium patch repairs the aortic annulus to assist aortic valve replacement

doi:10.3969/j.issn.2095-4344.2013.05.001

Abstract

Abstract:

BACKGROUND: Annulus calcification and paravalvular cysts often appear during aortic valve replacement. At this time, special techniques are generally used to assist the aortic valve replacement.
OBJECTIVE: To investigate the clinical feasibility of pericardium patch repaired aortic annulus to assist aortic valve replacement for the treatment of calcific aortic stenosis complicated by annulus calcification.
METHODS: Forty two patients with calcific aortic stenosis complicated by annulus calcification were selected from the First Affiliated Hospital of Zhengzhou University during January 2009 and January 2012. Their clinical data were retrospectively analyzed. The effective orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were analyzed with statistical software before and after pericardium patch repaired aortic annulus assisted aortic valve replacement, and then the effect of autologous pericardium patch repaired aortic annulus to assist aortic valve replacement was analyzed.
RESULTS AND CONLUSION: There was no intraoperative death during the pericardium patch repaired aortic annulus assisted aortic valve replacement. The intraoperative aortic clamping time was 52-88 (63.0±18.1) minutes, and the cardiopulmonary bypass time was 78-122 (102.6±25.1) minutes. One patient appeared acute renal failure after replacement, and cured after the bedside hemodialysis treatment. The rest patients had no serious complications. The length of hospital stay was 7-20 (13.6±5.5) days. The postoperative Doppler echocardiography showed the heart valve prosthesis was good, and no paravalvular leaks were found. The orifice area index of aortic valve, maximum transvalvular pressure gradient, peak blood flow velocity and left ventricular ejection fraction were significantly improved at 6 months after replacement, and the differences were significant when compared with those before replacement (P < 0.05). In patients with appropriate surgical indications, the autologous pericardium patch repaired aortic annulus assisted aortic valve replacement surgery can achieve satisfactory effects, and the operation is safe and simple, which is considered as a practicable technology.

Key words: organ transplantation, heart-lung transplantation, tissue transplantation, autologous pericardium patch, calcific aortic stenosis, heart valve prosthesis, aortic annulus, aortic valve replacement, echocardiography, photographs-containing paper of organ transplantation

CLC Number:

R318

Xia Bing, Wen Bing, Xu Hua-shan, Fu Guo-wei, Zhao Wen-zeng. Autologous pericardium patch repairs the aortic annulus to assist aortic valve replacement[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(5): 761-768.

Figures/Tables 2

References

[1] Zhang JQ,Lu JZ,Xiao MD,et al. Zhongguo Xinxueguanbing Yanjiu Zazhi. 2008;6(9):686-687.张建卿,卢继忠,肖明第,等.主动脉瓣环切除重建术在特殊换瓣患者中的应用探讨[J].中国心血管病研究杂志,2008,6(9):686-687.

[2] Zhang JQ,Li WB,Xiao MD,et al.Zhonghua Shiyong Zhenduan yu Zhiliao Zazhi. 2008;22(9): 696-697.张建卿,李温斌,肖明弟,等.冠脉开口移植及主动脉瓣环切除术在主动脉置换术中的应用[J].中华实用诊断与治疗杂志,2008, 22(9): 696-697.

[3] Pan WZ,Zhou DX,Ge JB. Zhonghua Xinxueguanbing Zazhi. 2012;40(2):166-168.潘文志,周达新,葛均波. 钙化性主动脉瓣疾病基础和临床研究进展[J].中华心血管病杂志,2012,40(2):166-168.

[4] Jiang JZ. Zhongguo Laonian Baojian Yixue. 2005;3(2):10-12.江金芝.老年性主动脉瓣钙化危险因素研究[J].中国老年保健医学,2005,3(2):10-12．

[5] Fraund S, Pethig K, Wahlers T,et al. ON-X bileaflet valve in aortic position--early experience shows an improved hemodynamic profile.Thorac Cardiovasc Surg. 1998;46(5): 293-297.

[6] Liu J,Zhao Q,Chen ZQ,et al. Zhongguo Linchuang Yixue. 2004;11(4):557-558.刘俊,赵强,陈志强,等.On-X机械主动脉瓣膜临床血流动力学观察[J].中国临床医学,2004,11(4):557-558.

[7] Shen HY. Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2009;13(26):5141-5144.申红亚.人工瓣膜置换对血流动力学影响的系统分析[J].中国组织工程研究与临床康复,2009,13(26):5141-5144.

[8] Zhang HB,Han J,Bai T,et al. Xinfei Xueguanbing Zazhi. 2008; 27(1):4-7.张海波, 韩杰,白涛,等.小左心室和大左心室患者进行相同机械二尖瓣置换术后围手术期血流动力学研究[J].心肺血管病杂志, 2008,27(1):4-7.

[9] Wang ZN,He B. Shanghai: Second Military Medical University Press, 2009:3-18.约翰•霍普金斯医院.心脏外科围术期处理手册[M].2版.王志农,何斌,译.上海:第二军医大学出版社,2009:3-18.

[10] Feng XY,Wang HC,Jia GL,et al. Disi Junyi Daxue Xuebao. 2001;22(13):1232.冯旭阳,王海昌,贾国良,等.风心病患者瓣膜置换术前冠状动脉造影检查的意义[J].第四军医大学学报,2001,22(13):1232.

[11] Wang HT,Yang SQ,Zhang H. Shandong Yiyao. 2008;48(47): 66-67.王宏涛,杨书强,张华.467例心脏瓣膜置换术患者围手术期的处理[J].山东医药,2008,48(47):66-67.

[12] Chen CH. Zhongguo Shiyong Huli Zazhi. 2009;25(30):30-31.陈朝红.心脏瓣膜置换术后常见并发症的观察及护理[J].中国实用护理杂志,2009,25(30):30-31.

[13] Huang YW,Zhu ZJ. Xiandai Shiyong Yixue. 2008;20(12): 919-922.黄元伟,朱志军.心力衰竭的临床评估与治疗[J].现代实用医学, 2008,20(12):919-922.

[14] Huang J. Xinxueguanbingxue Jinzhan. 2012;33(1):1-5.黄峻.慢性心力衰竭诊断和治疗2012:现状和进步[J].心血管病学进展,2012,33(1):1-5.

[15] 中华医学会心血管分会,中华心血管病杂志编辑委员会.慢性心力衰竭诊断治疗指南[J].中华心血管杂志,2007,35(12): 1076-1095.

[16] Bauset R, Dagenais F. Double valve replacement through an aorto-annulo-atriotomy using an aortic-valved graft in a mitral position.Ann Thorac Surg. 2002;73(6):1986-1987.

[17] Peterson MD, Borger MA, Feindel CM,et al. Aortic annular enlargement during aortic valve replacement: improving results with time. Ann Thorac Surg. 2007;83(6): 2044-2049.

[18] Hanayama N, Christakis GT, Mallidi HR,et al. Patient prosthesis mismatch is rare after aortic valve replacement: valve size may be irrelevant. Ann Thorac Surg. 2002;73(6): 1822-1829.

[19] Molina JE. Enlargement of the aortic annulus using a double-patch technique: a safe and effective method. Ann Thorac Surg. 2002;73(2):667-670.

[20] Zhu YB,Zhu B,Yang M,et al.Yixue Yanjiu Zazhi. 2012; 41(5) : 149-152.朱亚彬,朱兵,杨岷,等.Konno法和改良Manougnian法行主动脉瓣置换术的临床结果[J]. 医学研究杂志, 2012, 41(5) :149-152.

[21] Huang Y,Xiang JS,Yang ZJ,et al. Zhongguo Xiandai Shoushuxue Zazhi. 2010;14(5):347-349.黄勇,向加树,杨智杰,等. Manouguian法瓣环增宽加主动脉瓣置换术治疗成人小主动脉瓣环[J].中国现代手术学杂志, 2010, 14(5): 347-349.

[22] Zhu P,Wu RB,Zhuang J,et al. Nanfang Yike Daxue Xuebao. 2007;27(7):1125-1126.朱平,吴若彬,庄建,等.小主动脉瓣环扩大并主动脉瓣置换术18例报告[J].南方医科大学学报, 2007,27(7):1125-1126.

[23] Zhao GF. Yishi Jinxiu Zazhi. 2005;28(10):40-42.赵国芳.改良Nicks法行小主动脉瓣环扩大及主动脉瓣置换术[J].医师进修杂志,2005,28(10):40-42.

[24] Song SQ,Li WB,Chen BT,et al. Xinfei Xueguanbing Zazhi. 2009;28(1): 21-23.宋士秋,李温斌,陈宝田,等. 小瓣环主动脉瓣置换并主动脉瓣环扩大术的近中期结果[J].心肺血管病杂志, 2009, 28(1): 21-23.

[25] Li T,Huang JH,Wu QZ,et al. Zhonghua Xiongxin Xueguan Waike Zazhi. 2004;20(4):238.李韬,黄健宏,吴全忠,等.改良Nicks法瓣环扩大联合环上瓣置入治疗小瓣环主动脉瓣病变[J].中华胸心血管外科杂志, 2004, 20(4):238.

[26] Han L,Xu ZY,Zou LJ,et al. Zhonghua Xiongxinxueguan Waike Zazhi. 2011;27(2):90-92.韩林,徐志云,邹良建,等.瓣环结构重建的瓣膜置换手术[J].中华胸心血管外科杂志,2011,27(2):90-92.

[27] Liu ZM, Roland Hetzer,Weng YG. Beijing:People’s Medical Publishing House. 2010:524-526.刘中民,Roland Hetzer,翁渝国.实用心脏外科学[M].北京:人民卫生出版社,2010:524-526.

[28] Li XH,Xu ZY,Cao X. Shandong Yiyao. 2011;51(6):90-92.李先华,徐志云,曹翔.环上瓣植入与瓣环扩大在成人小主动脉瓣环换瓣术中的应用效果观察[J].山东医药,2011,51(6):90-92.

[29] Chen M,Li YZ. Zhongguo Linchuang Yixue. 2008;15(1):39-42.陈铭,李颖则.小主动脉瓣环在手术中的处理[J].中国临床医学, 2008,15(1):39-42.

[30] Gillinov AM, Blackstone EH, Alster JM,et al. The Carbomedics Top Hat supraannular aortic valve: a multicenter study. Ann Thorac Surg. 2003;75(4):1175-1180.

[31] Ghosh P, Kumar S, Pandey S,et al. Small aortic annulus: a functional definition. Ann Thorac Cardiovasc Surg. 1998;4(5): 251-261.

[32] Xu ZY,Tang H,Xu JB,et al. Zhongguo Xiongxinxueguan Waike Linchuang Zazhi. 2012;19(1):1-3.徐志云,唐昊,徐激斌,等.非原位主动脉瓣置换术治疗主动脉瓣环严重毁损性病变的方法与疗效[J].中国胸心血管外科临床杂志, 2012,19(1):1-3.

[33] Sun HB. Zhongguo Yiyao Zhinan. 2012;10(28):133-134.孙红斌.小主动脉瓣环者接受机械瓣膜置换术后的远期疗效分析[J].中国医药指南,2012,10(28):133-134.

[34] Li JY,Zhang JQ,Bo P,et al. Zhongguo Xiongxinxueguan Waike Linchuang Zazhi. 2008;15(5):329-332.李继勇,张健群,伯平,等.小主动脉瓣环患者机械瓣置换术后中期疗效分析[J].中国胸心血管外科临床杂志,2008,15(5):329-332.

[35] Gao BT,Zheng JH,Liu YJ,et al. Shanghai Jiaotong Daxue Xuebao:Yixueban. 2011;31(9):1352-1354.高波涛,郑景浩,刘玉洁,等.自体心包补片在婴幼儿简单室间隔缺损修补中的应用[J].上海交通大学学报:医学版,2011,31(9): 1352-1354.

[36] Liu JF. Beijing:Peking University Medical Press. 2009:29-30.刘锦纷.先天性心脏病外科综合治疗学[M].北京:北京大学医学出版社,2009:29-30.

[37] Sun BP,Zhang ZW,Yu JG,et al. Zhonghua Xiongxinwaike Zazhi. 2011;27(6):354-356.孙柏平,张泽伟,俞建根,等.ASO术中自体心包重建肺动脉根部[J].中华胸心血管外科杂志,2011,27(6):354-356.

[38] Xu J,Shu LL,Zhao WZ. Zhengzhou Daxue Xuebao:Yixueban. 2004;39(3):513-514.徐敬,舒礼良,赵文增.重症心脏瓣膜病外科治疗38例体会[J].郑州大学学报:医学版,2004,39(3):513-514.

[39] Prifti E, Bonacchi M, Bernabei M, et al. Repair of complete atrioventricular septal defect with tetralogy of fallot: our experience and literature review.J Card Surg. 2004;19(2): 175-183.

[40] Isomatsu Y, Shin'oka T, Aoki M, et al. Establishing right ventricle-pulmonary artery continuity by autologous tissue: an alternative approach for prosthetic conduit repair.Ann Thorac Surg. 2004;78(1):173-180.

[41] Bennink GB, Hitchcock FJ, Molenschot M, et al. Aneurysmal pericardial patch producing right ventricular inflow obstruction. Ann Thorac Surg. 2001;71(4):1346-1347.

[42] D'Andrilli A, Ibrahim M, Venuta F,et al. Glutaraldehyde preserved autologous pericardium for patch reconstruction of the pulmonary artery and superior vena cava.Ann Thorac Surg. 2005;80(1):357-358.

[43] Qian XM,Zhong SZ. Nanfang Yike Daxue Xuebao. 2009; 29(10): 2055-2058.钱希明,钟世镇.主动脉瓣不匹配对老年病人术后生活质量的影响[J].南方医科大学学报,2009,29(10):2055-2058.

[44] Yu T,Xie DX,Wang YZ,et al. Zhongguo Xiongxinxueguan Waike Linchuang Zazhi. 2008;15(3):230-232.于涛,谢定雄,王延震,等.成人小主动脉瓣环患者的心瓣膜置换术[J].中国胸心血管外科临床杂志,2008,15(3):230-232.

[45] Chen JW,Luo RF,Zhong HQ,et al. Zhonghua Quanke Yixue. 2009;7(2):132-133.陈景伟,罗瑞芳,钟焕清,等.主动脉瓣环扩大术在主动脉瓣置换术中的应用[J].中华全科医学,2009,7(2):132-133.

[46] Wu Z,Wang DJ,Li J,et al. Zhonghua Xiongxinxueguan Waike Zazhi. 2010;26(6):374-376.武忠,王东进,李捷,等.主动脉瓣置换术后人工心脏瓣膜-病人不匹配现象[J].中华胸心血管外科杂志,2010,26(6):374-376.

[47] Walther T, Rastan A, Falk V,et al. Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement.Eur J Cardiothorac Surg. 2006;30(1):15-19.

[48] Moon MR, Pasque MK, Munfakh NA,et al. Prosthesis-patient mismatch after aortic valve replacement: impact of age and body size on late survival.Ann Thorac Surg. 2006;81(2): 481-488.

[49] Nouette K, Richebé P, Calderon J,et al. Perioperative anticoagulation management for prosthetic heart valves.Ann Fr Anesth Reanim. 2005;24(6):621-631.

[50] Li T,Cai ZJ,Liu WY,et al. Zhongguo Xiongxinxueguan Waike Linchuang Zazhi. 2006;13(3):197-198.李彤,蔡振杰,刘维永,等.生物瓣心瓣膜置换术后远期疗效[J].中国胸心血管外科临床杂志,2006,13(3):197-198.

[51] Chu YL,Li L,Wu YY,et al. Zhongguo Xunhuan Zazhi. 2006; 21(2):140-142.褚衍林,李鲁,吴英渝,等.风湿性心脏瓣膜替换术后远期疗效观察[J].中国循环杂志,2006,21(2):140-142.