外科瓣膜手術治療主動脈瓣閉鎖不全之臨床成效

主動脈瓣閉鎖不全的症狀，通常反映了肺靜脈高壓，常見的有活動性喘及端坐呼吸等等。根據最新瓣膜性心臟病的治療指引，主動脈瓣閉鎖不全的手術適應症包括：已產生症狀、左心室擴大或收縮異常，以及必須接受其他心臟手術時。傳統主動脈瓣閉鎖不全的手術，透過修補或置換來恢復瓣膜功能。當疾病已侵犯主動脈瓣環或是主動脈根部時，則會選擇根據不同情形考慮保留瓣膜與否，進行主動脈根部置換手術。本文我們將分享主動脈瓣膜手術的相關經驗。近年來，微創心臟手術已經快速發展。對於主動脈瓣閉鎖不全，尤其是單獨主動脈瓣手術，微創是很好的選擇。主動脈瓣手術的微創手術方式有許多變化，包含部分胸骨切開、側胸小傷口以及我們偏好的胸骨旁路徑。我們同時也將亞東醫院做微創手術的經驗供大家參考。在如今，對待每一個病人都需要多團隊介入、以病人為中心的思考。至少在讓醫病共享決策前，醫療端要對能提供的選擇要有一定的共識。

關鍵字

主動脈瓣手術；微創心臟手術；主動脈瓣逆流

並列摘要

Patients with aortic regurgitation (AR) usually have symptoms reflecting pulmonary venous hypertension, including exertional dyspnea, orthopnea, etc. According to the recent guidelines for valvular heart disease, the indications of surgery for AR include symptomatic disease, LV dysfunction, or concomitant surgery. The operation method for AR is trying to restore the valve competency by aortic valve repair (AVP) or aortic valve replacement (AVR). In cases of annulus involvement or diseases involving aortic root, replacement of aortic valve and aortic root en bloc or valve-sparing aortic root replacement may be performed in different situations. For this particular forum, we will share our experience of isolated aortic valve surgery and concomitant surgery for AR. In recent years, minimally invasive cardiac surgery (MICS) has developed rapidly. For patients with AR, MICS could be a suitable choice, especially for isolated aortic valve surgery. I will share about different minimally invasive approaches for aortic valve surgery, including partial sternotomy, thoracotomy, and my favorite-parasternotomy. Multidisciplinary, patient-centered approaches to finding out the best approach for each single patient will be acknowledged in the evolving era. At least physicians need to have some sort of consensus prior to patient-physician shared decision making!

並列關鍵字

aortic valve surgery ； minimal invasive cardiac surgery ； aortic regurgitation

參考文獻

Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol 1999;83:897-902. doi: 10.1016/S0002-9149(98)01064-9

El Khoury G, Glineur D, Rubay, et al. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol 2005;20:115-21. doi: 10.1097/01.hco.0000153951.31887.a6

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e35-e71. doi: 10.1161/CIR.0000000000000960

Ryan CT, Almousa A, Zea-Vera R, et al. Outcomes of aortic valve replacement for chronic aortic insufficiency: Analysis of the society of thoracic surgeons database. Ann Thorac Surg 2022;113:763-72. doi: 10.1016/j.athoracsur.2021.04.027

Mentias A, Feng K, Alashi A, et al. Long-term outcomes in patients with aortic regurgitation and preserved left ventricular ejection fraction. J Am Coll Cardiol 2016;68:2144-53. doi: 10.1016/j.jacc.2016.08.045

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