Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Recent Early Operative Outcomes of Comprehensive Aortic Root & Valve Reconstruction (CARVAR) Procedure

종합적 대동맥 근부 및 판막 재건술의 최근 초기 수술성적

  • Lee, Sung-Jun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Shin, Je-Kyoun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Kim, Dong-Chan (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Kim, Jin-Sik (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Kim, Jun-Seok (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Chee, Hyun-Keun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University) ;
  • Song, Meong-Gun (Department of Thoracic and Cardiovascular Surgery, Konkuk University Medical Center, School of Medicine, Konkuk University)
  • 이성준 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 신제균 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 김동찬 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 김진식 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 김준석 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 지현근 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실) ;
  • 송명근 (건국대학교 의학전문대학원 건국대학교병원 흉부외과학교실)
  • Published : 2009.12.05
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Abstract

Background: A Comprehensive Aortic Root and Valve Reconstruction (CARVAR) procedure is comprised of aortic root wall reconstruction and corrections of the leaflets for treating various aortic valve diseases. We evaluated our recent early clinical experience with the CARVAR procedure. Material and Method: From October 2007 to September 2008, 114 cases (66 males) of CARVAR procedures were performed, The mean patient age was 53 years (range: 14~84) The patients were divided into 4 groups: 1) the AAR group: aortic regurgitation with aortic root wall deformity such as annulo-aortic ectasia or ascending aortic aneurysm (n=18), 2) the IAR group: isolated AR with leaflet abnormality (n=42), 3) the IAS group: isolated aortic stenosis (n=51) and 4) the PAVR group: previous aortic valve replacement (n=3). Sinotubular junction (STJ) reduction was done in all the patients, leaflet correction was done in 10 of the AAR group patients and in all the patients of the other groups, annulus reduction was done in 14 of the MR group patients and in 6 of the IAR group patients. Aortic dissection was excluded from this analysis. Result: There was no mortality or follow-up death. The diameter of the aortic sinus decreased from $54.6{\pm}8.4$ mm to $38.3{\pm}3.8$ mm in the AAR group, the mean AR grade decreased from 3.2 to 0.2 in the IAR group, the mean aortic valve pressure gradient decreased from $47.1{\pm}24.4$ mmHg to $15.1{\pm}11.7$ mmHg in the IAS group and the mean AR grade decreased to 0 in the PAVR group. Balloon type coronary perfusion cannula-related coronary ostial stenosis developed in 4 patients and this was treated with OPCAB in three patients and with PTCA in one patient. Two patients developed postoperative infectious endocarditis. All the patients were discharged and followed up in a stable condition. Conclusion: The CARVAR procedure showed excellent short term results, but a good further follow up result is required to apply this procedure to most kinds of aortic valve diseases.

배경: 다양한 대동맥판막질환의 대동맥 근부 및 판막엽에 적용할 수 있는 종합적 대동맥근부 및 판막재건술(comprehensive aortic root and valve reconstruction, CARVAR)이 개발되어 시행되고 있으며, 최근의 초기 임상 성적을 알아보고자 하였다. 대상 및 방법: 2007년 10월부터 2008년 9월까지 대동맥 판막질환으로 CARVAR 수술을 받은 114명을 대상으로 하였다. 남자는 66명, 평균나이는 53 (범위 14~84)세였다. 환자는 질환에 따라 AAR group: 대동맥 근부 이상에 의한 대동맥판막 폐쇄부전증 그룹(n=18), IAR group: 판막엽 이상에 의한 대동맥판막 페쇄부전증 그룹(n=42), IAS group: 대동맥판막 협착증 그룹(n=51), PAVR group: 이전에 대동맥판막 치환술을 받은 그룹(n=3)으로 구분하였다. 동관연결부(sinotubular junction) 축소술은 114예 모두에서 시행하였으며 대동맥판막륜(aortic annulus)축소술은 AAR그룹의 14예와 IAR그룹의 6예에서 시행하였다. 대동맥판막엽 재건은 AAR그룹의 10예를 제외한 모두에서 시행하였고, 대동맥 박리증에 의한 대동맥 판막 질환 그룹은 이 연구에서 제외하였다. 결과: 수술 사망이나 추적 사망은 없었다. AAR그룹에서는 동맥동의 직경이 평균 술전 $54.6{\pm}8.4$ mm에서 술후 $38.3{\pm}3.8$ mm로 감소하였고 IAR그룹에서는 폐쇄부전의 정도가 평균 술전 grade 3.2에서 술후 0.2로 감소하였으며 IAS그룹에서는 대동맥판구의 평균압력차이가 술전 $47.1{\pm}24.4$ mmHg에서 술후 $15.1{\pm}11.7$ mmHg로 감소하였다. 그리고 PAVR그룹에서는 페쇄부전의 정도가 술전 grade 3에서 술후 0로 감소하였다. 풍선형 관동맥 관류관으로 인한 관상동맥협착증이 4명에서 발생하였으며 술후 심내막염이 2명에서 발생하였다. 모든 환자는 퇴원하여 현재 외래에서 안정된 상태로 추적 관찰 중에 있다. 결론: 종합적 대동맥근부 및 판막 재건술(comprehensive aortic root and valve reconstruction, CARVAR)은 좋은 초기 임상 성적을 보였으며 모든 대동맥판막질환에 적용할 수 있기 위하여 좋은 중장기 임상성적이 필요할 것으로 생각된다.

Keywords

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