Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Early Results of Aortic Valve-sparing Procedures in Patients with Annuloaortic Ectasia

대동맥륜대동맥확장(Annuloaortic Ectasia) 환자에서 대동맥판막을 보존하면서 시행된 대동맥근부 및 상행대동맥 치환술의 단기 성적

  • Sung Kiick (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Park Kay-Hyun (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Lee Young Tak (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Jun Tae-Gook (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Yang Ji-Hyuk (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Kim Su Wan (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Kim Jin Sun (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Cho Sung Woo (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Kim Si Wook (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Choi Jin Ho (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine) ;
  • Park Pyo Won (Department of Thoracic and Cardiovascular Surgery of Samsung Seoul Hospital, Sungkwunkwan University School of Medicine)
  • 성기익 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 박계현 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 이영탁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 전태국 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 양지혁 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김수완 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김진선 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 조성우 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김시욱 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 최진호 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 박표원 (성균관대학교 의과대학 삼성서울병원 흉부외과)
  • Published : 2005.07.01
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Abstract

Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. Material and Method: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of $37.9\pm19.2$ years (range: 6 months-74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). Result: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intraoperative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was $21.2\pm27.4$ months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no reoperation. Conclusion: Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.

대동맥판막을 치환하지 않고 보존하면서 대동맥근부 및 상행대동맥을 치환하는 경우 장기적으로 인공판막과 관련된 합병증을 줄여줄 수 있지만, 수술과 관련된 위험도를 증가시킬 수 있어 일반적으로 잘 시행되지는 않는다. 이에 본 병원의 이 수술과 관련된 위험도를 중심으로 단기성적을 알아보고자 하였다. 대상 및 방법: 1996년 5월부터 2003년 7월까지 26명의 환자에서 시행되었으며 남녀비는 17:9, 평균연령은 $37.9\pm19.2$세(범위: 6개월$\~74$세)로 말판증후군환자는 15명, 베체트 질환자가 1명이었다. 상행대동맥 박리가 있었던 환자는 10명이었으며, 중등도(moderate) 이상의 대동맥판막 역류가 있었던 환자가 18명이었다. 판막보존방법으로 재이식수술(reimplantation) 및 재형성수술(remodeling) 방법이 각각 14명과 12명에서 시행되었다. 동반된 수술로 대동맥판막 성형술이 6명, 승모판막 성형술이 5명, 부분대동맥궁치환술(hemiarch replacement)이 4명, 전대동맥궁치환술(total arch replacement)이 2명, 관상동맥우회술과 Maze수술이 각각 1명 등에서 시행되었다. 결과: 4명의 환자에서 수술 중 벤탈수술 등으로 전환하였으나, 모든 환자에서 수술 및 재원기간 내 사망은 없었고, 출혈에 의한 재수술이 3명, 박동기 삽입이 필요한 경우가 1명에서 있었다. 모든 환자의 중환자실 체류시간의 중간 값은 45.5시간이었으며, 재원기간의 중간 값은 10.5일이었다. 수술 중 전환한 환자를 제외한 22명 중, 수술장에서 시행한 경식도 심초음파를 시행한 모든 환자에서 경도(mild) 이하의 대동맥판막 역류를 보였으며, 수술장에서 경식도초음파를 시행하지 못했던 초기 한명의 환자에서 퇴원시 중등도(moderate)의 판막 역류가 있었다. 평균 추적관찰기간은 $21.2\pm27.4$개월로 타과 수술 중 사망한 1명의 환자를 제외한 모든 환자에서 생존을 확인하였으며, 3명의 환자에서 중등도 이상의 대동맥판막 역류가 재발하였으나 재수술은 없었다. 결론. 대동맥륜대동맥확장 환자에서 대동맥판막을 보존하면서 대동맥근부 및 상행대동맥을 치환하는 수술이 선별된 환자에서 비교적 안전하게 시행될 수 있는 방법으로 사료된다.

Keywords

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