文献[1-2]报道，主动脉夹层每年的发病率为 2.9～4.7 例/10 万。急性主动脉 A 型夹层是危急生命的急症，外科手术是治疗急性主动脉 A 型夹层最重要的方法。A 型夹层的破口一般位于升主动脉，夹层逆撕至主动脉瓣交界可以造成主动脉瓣反流，主动脉夹层累及主动脉根部导致主动脉瓣反流的比例约为 40%～60%[3-5]。夹层一般不累及瓣环和瓣叶，有学者提出保留主动脉瓣的根部修复手术[6-8]。由于远期主动脉瓣远期反流和残余主动脉窦扩张的问题，有些学者主张首次手术行主动脉根部置换术。因此目前对于急性主动脉 A 型夹层导致的主动脉瓣反流的处理存在一定争议。
本研究主要评估三种主动脉根部修复方法：主动脉瓣交界悬吊、单纯升主动脉置换、主动脉根部置换术（Bentall 手术），在主动脉夹层累及主动脉根部患者的近远期效果。
1 资料与方法
1.1 临床资料
收集 2010 年 1 月 1 日至 2015 年 12 月 31 日期间，在阜外医院行主动脉夹层修复手术的患者资料。累及主动脉根部的急性主动脉 A 型夹层手术的患者总共 673 例，男 512 例、女 161 例，平均年龄（48.8±11.22）岁。主动脉瓣交界悬吊组共 403 例，其中男 287 例、女 116 例，平均年龄（50.61±9.95）岁。升主动脉置换组 95 例，男 76 例、女 19 例，平均年龄（49.83±12.21）岁。主动脉根部置换组 175 例，男 149 例、女 26 例，平均年龄（44.07±11.99）岁。患者的诊断主要来源于主动增强 CT，瓣膜情况由经胸心脏超声评估或者术中经食管超声评估。
1.2 研究定义
急性主动脉夹层是指发病距离手术时间≤14 d 的患者[9]。肝功能不全是指转氨酶或者胆红素升高>正常值 4 倍。术前肾功能不全是指肌酐水平>3.0 mg/dl，术后急性肾损伤是指肌酐>术前基础值的 2 倍或者需要肾脏替代治疗。脊髓缺血是指下肢失去感觉，活动障碍。持续性神经系统功能损伤是指出院时仍然存在神经系统功能障碍，包括运动、感觉功能异常以及精神障碍。延迟拔管是指机械通气超过 24 h。术后心功能不全是指室性心律失常、心肌梗死、心包积液、心室机械辅助等。
1.3 手术策略
根据夹层累及的主动脉瓣交界个数，将交界受累分为三度：轻度（0～1）、中度（2）、重度（3）。手术中根据主动脉根部直径，主动脉瓣交界受累的程度和主动脉瓣结构决定根部处理的方式。若主动脉根部直径<45 mm，主动脉瓣交界中度以上受累，主动脉瓣结构正常，选择主动脉瓣交界悬吊，术中用缝线褥式缝合将主动脉瓣交界固定于瓣环水平。若主动脉瓣交界轻度受累，主动脉窦直径<45 mm，主动脉瓣结构无异常，术中清除主动脉窦内血栓，采用连续缝合的方法缝闭假腔，然后在冠状动脉上方与人工血管端端吻合行单纯升主动脉置换。若主动脉窦直径≥45 mm，主动脉瓣结构异常，如钙化、穿孔等，或者合并结缔组织病，不考虑主动脉瓣交界累及程度，均选择主动脉根部置换术。阜外医院根据夹层累及的主动脉范围选择人工血管置换的范围。若单纯累及升主动脉，行单纯升主动脉置换。若累及部分主动脉弓，行升主动脉+部分主动脉弓置换或者升主动脉+次全主动脉弓置换。当行部分弓置换时，采用浅低温单泵双管灌注方法，股动脉插管，术中将另一根动脉插管插入无名动脉，主动脉弓远端吻合完毕后，撤除无名动脉插管，无名动脉与分支血管完成吻合；当行次全主动脉弓置换时，利用球囊阻断降主动脉，开放吻合主动脉弓远端，吻合完毕后用阻断钳阻断人工血管，逐一完成左颈总动脉和无名动脉与分支血管的吻合。若累及全主动脉弓，行升主动脉+全主动脉弓置换，若累及全主动脉弓及降主动脉的患者行升主动脉+全主动脉弓置换+支架象鼻术，通过腋动脉插管，采用深低温停循环技术，术中降主动脉置入支架血管，人工血管与降主动脉和支架血管吻合，吻合完毕后通过单泵双管恢复全身灌注，逐一完成分支血管的重建。主动脉夹层阜外分型这篇文章有对主动脉夹层手术方式选择的详细描述[10]。
1.4 统计学分析
本研究应用统计软件 SAS9.4 对数据进行分析。由于连续变量不服从正态分布，因此连续变量和分类变量均采用 Kruskal Wallis 秩和检验。应用 logistic 回归模型进行单因素和多因素危险因素分析。采用 Kaplan-Meier 曲线对患者进行远期的存活情况、免于主动脉瓣中量以上反流、再手术干预情况进行统计分析。P<0.05 为差异有统计学意义。
2 结果
2.1 术前变量
591 例（87.8%）A 型夹层患者不同程度的主动脉瓣交界受累，主动脉瓣交界悬吊组轻度、中度、重度受累比例分别为 31.7%，52.4%，15.9%；升主动脉置换组的交界轻度、中度、重度受累比例分别为 87.4%，12.6%，0.0%；Bentall 组主动脉瓣交界轻度、中度、重度受累的比例为 23.4%，56.0%，20.6%，三组差异具有统计学意义（P<0.01）。全组主动脉窦>45 mm 有 190 例，占 28.23%，<45 mm 占 71.77%。三组的主动脉窦直径分别为（39.06±5.11）mm、（38.27±4.41）mm 和（50.39±6.22）mm，三组差异有统计学意义（P<0.01）；见表 1 。交界受累个数增加，主动脉瓣反流的程度增加，3 个交界受累导致主动脉瓣中量及以上反流占 69.0%，主动脉瓣交界受累的程度与主动脉瓣反流的关系见图 1 。随着主动脉瓣反流程度的加重，主动脉瓣悬吊的比例下降，Bentall 手术的比例增加，单纯升主动脉置换组中以无反流或少量反流为主。三组的主动脉瓣反流的分布情况见图 2 。
表1
两组患者术前临床资料比较［
/例（%）］
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表1
两组患者术前临床资料比较［
/例（%）］
/例（%）］
| 变量 | 交界悬吊组（n=403） | 升主置换组（n=95） | Bentall 组（n=175） | P 值 |
| 年龄 | 50.61±9.97 | 49.83±12.28 | 44.07±12.03 | <0.01 |
| 男性 | 287（71.2） | 76（80.0） | 149（85.1） | <0.01 |
| BMI（kg/m2） | 26.1±3.7 | 25.8±3.9 | 24.9±4.3 | <0.01 |
| 高血压 | 325（80.6） | 78（82.1） | 85（48.6） | <0.01 |
| 糖尿病 | 11（2.7） | 1（1.1） | 1（0.6） | 0.18 |
| 马方综合征 | 16（4.0） | 5（5.3） | 43（24.6） | <0.01 |
| 合并根部瘤 | 3（0.7） | 0（0.0） | 22（12.6） | <0.01 |
| 合并冠心病 | 13（3.2） | 4（4.2） | 5（2.9） | 0.83 |
| 射血分数（%） | 60.3±4.8 | 60.1±4.6 | 59.7±6.0 | 0.65 |
| 肾功不全 | 27（6.7） | 4（4.2） | 8（4.6） | 0.47 |
| 肝功不全 | 14（3.5） | 2（2.1） | 6（3.4） | 0.79 |
| De Bakey Ⅰ 型夹层 | 391（97.0） | 79（83.2） | 161（92.0） | <0.01 |
| De Bakey Ⅱ 型夹层 | 12（2.9） | 16（16.8） | 14（8.0） | <0.01 |
| 升主动脉直径 | 43.66±6.19 | 42.32±7.52 | 50.17±10.5 | <0.01 |
| 窦直径 | 39.06±5.11 | 38.27±4.41 | 50.39±6.22 | <0.01 |
| 瓣环直径 | 23.87±2.3 | 23.79±2.82 | 26.31±3.18 | <0.01 |
| 交界受累个数 | <0.01 | |||
| 0 个 | 11（2.7） | 55（57.） | 16（9.1） | |
| 1 个 | 117（29） | 28（29.5） | 25（14.3） | |
| 2 个 | 211（52.4） | 12（12.6） | 98（56.0） | |
| 3 个 | 64（15.9） | 0（0.0） | 36（20.6） | |
| 主动脉瓣反流中量
至大量 |
110（27.3） | 6（6.3） | 173（98.9） | <0.01 |
| 主动脉瓣反流大量 | 2（0.5） | 1（1.1） | 2（11.1） | <0.01 |
| BMI：体重指数 | ||||
2.2 术中变量
三组的手术时间、体外循环时间、主动脉阻断时间以及停循环时间差异均有统计学意义（P<0.01）。Bentall 组的体外循环时间和主动脉阻断时间最长，分别为 （202.24±75.89）min 和 （105.88±30.53）min。全组行传统的全主动脉弓置换术 612 例，占 90.93%，部分主动脉弓置换术 45 例，占 6.69%，单纯升主动脉置换术 16 例，占 2.38%；见表 2 。
表2
两组患者术中临床资料比较［
/例（%）/中位数（四分位数间距）］
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表2
两组患者术中临床资料比较［
/例（%）/中位数（四分位数间距）］
/例（%）/中位数（四分位数间距）］
| 变量 | 交界悬吊组（n=403） | 升主动脉置
换组（n=95） |
Bentall 组（n=175） | P 值 |
| 手术时间（min） | 409.01±126.03 | 356.36±105.6 | 405.93±125.96 | <0.01 |
| CPB 时间（min） | 189.87±56.1 | 169.21±57.34 | 202.24±75.89 | <0.01 |
| 阻断时间（min） | 95.35±30.62 | 78.89±25.92 | 105.88±30.53 | <0.01 |
| 停循环时间
（min） |
23.38±6.51 | 22.36±6.94 | 22.06±5.31 | 0.13 |
| 手术方式 | 0.03 | |||
| 全弓置换 | 376（93.3） | 81（85.3） | 155（88.6） | |
| 部分弓置换 | 2（0.5） | 3（3.2） | 11（6.3） | |
| 升主动脉置换 | 25（6.2） | 11（11.6） | 9（5.2） | |
| CABG | 38（9.4） | 5（5.3） | 19（10.9） | 0.31 |
| 股动脉旁路术 | 10（2.5） | 1（1.1） | 7（4.0） | 0.33 |
| 术中失血量（ml） | 950.0（620.0） | 900.0（600.0） | 980.0（580.0） | 0.10 |
| 红细胞（U） | 8.0（6.0） | 8.0（5.0) | 8.0（5.0） | 0.04 |
| 血浆（ml） | 900.0（800.0) | 950.0（760.0） | 900.0（700.0） | 0.87 |
| 血小板（U） | 2.0（2.0） | 2.0（1.0） | 2.0（2.0） | 0.01 |
| CPB：体外循环；全弓置换包括：全主动脉弓+支架象鼻术，杂交全主动脉弓置换；部分弓置换包括：部分主动脉弓置换，次全主动脉弓置换；CABG：冠状动脉旁路移植术 | ||||
2.3 术后变量
全组院内死亡率为 11.73%。主动脉瓣交界悬吊组、升主动脉置换组、Bentall 组的院内死亡率分别为 12.2%、13.7%、9.7%，三组差异无统计学意义（P=0.58）。三组术后肾功能不全的发生率分别为 38.0%，26.3%，21.7%，差异有统计学意义（P<0.01）。三组 ICU 停留时间分别为 76.0（24.0）h、66.0（45.0）h、62.0（35.0）h，差异有统计学意义（P<0.01）；见表 3 。院内生存患者出院时心脏超声评估主动脉瓣反流情况，主动脉瓣交界悬吊组存活出院 403 例，其中少量反流 55 例（13.65%），中量反流 5 例（1.24%）。升主动脉置换组生存出院 78 例，其中少量反流 6 例（7.69%）。Bentall 组患者出院时未发现反流，瓣膜功能正常。术后患者反流情况见图 3a。
表3
两组患者术后临床资料比较［
/例（%）/中位数（四分位数间距）］
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表3
两组患者术后临床资料比较［
/例（%）/中位数（四分位数间距）］
/例（%）/中位数（四分位数间距）］
| 变量 | 交界悬吊组（n=403） | 升主置换组（n=95） | Bentall 组（n=175） | P 值 |
| 院内死亡率 | 49（12.2） | 13（13.7） | 17（9.7） | 0.58 |
| 术后通气时间（h） | 25.48±24.21 | 26.84±28.11 | 24.53±24.5 | 0.15 |
| 延迟拔管 | 20（5.0） | 9（9.5） | 8（4.6） | 0.18 |
| 气管切开 | 8（2.0） | 0（0.0） | 2（1.1） | 0.32 |
| 肾功不全 | 153（38.0） | 25（26.3） | 38（21.7） | <0.01 |
| 血滤 | 49（12.2） | 10（10.5） | 17（9.7） | 0.67 |
| 肝功不全 | 133（33.0） | 22（23.2） | 60（34.3） | 0.13 |
| 持续神经损伤 | 30（7.4） | 6（6.3） | 10（5.7） | 0.73 |
| 脊髓损伤 | 20（5.0） | 4（4.2） | 7（4.0） | 0.86 |
| 心功能不全 | 9（2.2） | 2（2.1） | 6（3.4） | 0.67 |
| 开胸止血 | 11（2.7） | 4（4.2） | 2（1.1） | 0.28 |
| ICU 停留时间（h） | 24（76.0） | 45（66.0） | 35（62.0） | <0.01 |
| 住院时间（d） | 6（14.0） | 4（16.0） | 8（14.0） | 0.60 |
| ICU：重症监护室 | ||||
2.4 危险因素分析
术前肾功能不全 [odds ratio（OR）=3.38， 95% confidence interval（CI）=1.16～9.81，P=0.01] 和术后肾功能不全 （OR=3.56，95% CI=1.59～7.99， P<0.01）均是院内死亡的独立危险因素，手术方式不是院内死亡的危险因素；见表 4。年龄（OR=1.04，95% CI=1.02～1.08， P<0.01）和术前肾功能不全（OR=2.83，95% CI=1.11～7.25， P=0.03）是远期死亡的危险因素，手术方式不是远期死亡的危险因素；见表 5。
表4
院内死亡多因素分析
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表4
院内死亡多因素分析
| 变量 | OR 值 | 95% 可信区间 | P 值 |
| 术前肾功不全 | 3.38 | 1.16～9.81 | 0.01 |
| CPB 时间 | 1.01 | 1.01～1.02 | <0.01 |
| 术中红细胞用量 | 1.01 | 1.00～1.02 | 0.04 |
| ICU 停留时间 | 0.99 | 0.99～0.99 | 0.01 |
| 开胸止血 | 7.88 | 1.71～36.44 | <0.01 |
| 术后肾功不全 | 3.56 | 1.59～7.99 | <0.01 |
| 术后血滤 | 7.89 | 3.26～19.08 | <0.01 |
| 术后心功能不全 | 12.10 | 1.16～126.45 | 0.04 |
| 住院时间 | 0.95 | 0.92～0.98 | <0.01 |
| CPB：体外循环；ICU：重症监护室 | |||
表5
远期死亡多因素分析
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表5
远期死亡多因素分析
| 变量 | OR 值 | 95% 可信区间 | P 值 |
| 年龄 | 1.04 | 1.02～1.08 | <0.01 |
| 术前肾功不全 | 2.83 | 1.11～7.25 | 0.03 |
| ICU 停留时间 | 0.99 | 0.99～0.99 | <0.01 |
| CPB 时间 | 1.01 | 1.01～1.01 | <0.01 |
| 开胸止血 | 4.85 | 1.30～18.07 | 0.02 |
| 术后血滤 | 10.88 | 5.45～21.71 | <0.01 |
| CPB：体外循环；ICU：重症监护室 | |||
2.5 随访结果
出院时存活的 597 例患者的平均随访时间 3.06 （ 0.51～6.77 ）年。失访 40 例，占 5.94%。主动脉瓣交界悬吊组、单纯升主动脉置换组、Bentall 组的 5 年生存率分别为 83.06%、81.27%、83.05%（P=0.85）；见图 4 。主动脉瓣交界悬吊组、单纯升主动脉置换组、Bentall 组 5 年主动脉瓣反流的分布情况见图 3b ，免于中量以上主动脉瓣反流的比例分别为 95.2%、98.6%、100.0%（P=0.07）；见图 5 。主动脉瓣交界悬吊组、单纯升主动脉置换组、Bentall 组均未出现因根部病变再次手术。
3 讨论
为了降低手术风险，对急性主动脉 A 型夹层，外科医生会选择单纯置换冠状动脉以上的升主动脉[11]。但是如果主动脉根部严重受累，有学者提出进行主动脉根部置换[12]。主动脉根部置换术会延长手术时间、提高术后并发症的发生率[13-14]。而保留自体主动脉瓣可以避免人工瓣膜的毁损，防止出血和血栓事件的发生，以及防止长期抗凝延缓假腔血栓化等[15]。还有学者提出用自体肺动脉瓣、同种主动脉瓣行根部修复术[16]。本中心总结近 5 年对于夹层累及主动脉根部处理技术的经验，发现约三分之二的患者行主动脉瓣交界悬吊术进行主动脉根部修复，因此主动脉瓣交界悬吊技术正逐渐被外科医生所应用。
主动脉夹层导致的急性主动脉瓣关闭不全主要是由于夹层逆撕，主动脉瓣交界撕脱所致[11]。通过本组分析 70% 主动脉 A 型夹层患者的主动脉窦直径均<45 mm，因此大部分主动脉夹层根部扩张不明显，不需要置换主动脉窦，因此我们可以通过主动脉瓣交界受累的程度来选择具体手术方式。本组中 91.36% 的主动脉瓣反流存在主动脉瓣交界受累，而且主动脉瓣交界受累个数越多，主动脉瓣反流的情况越严重。主动脉瓣交界悬吊组术前存在主动脉瓣反流占 66.5%，通过主动脉瓣交界悬吊，术后早期少量以下主动脉瓣反流占 98.76%，远期随访少量以下的主动脉瓣反流占 97.27%。因此，主动脉瓣交界悬吊可以有效解决主动脉夹层导致的主动脉瓣反流。而对于交界轻度受累的患者，通过清除主动脉窦的血栓，闭合假腔后同样可以达到解除主动脉瓣反流的目的。当然，如果术中通过食管超声评估主动脉瓣反流的机制和严重程度，协助判断瓣叶质量，可以帮助外科医生更好地判断主动脉瓣修复是否能取得成功[17]。而对于主动脉根部直径>45 mm，尽管交界轻度受累也应该考虑行主动脉根部置换。本研究中主动脉根部置换组患者根部平均直径为 50.39 mm，而其余两组的根部平均直径均<45 mm，而且主动脉根部置换组的根部瘤的比例和马方综合征的比例均为三者最高。
本研究全组的手术死亡率为 11.73%，大部分文献报道的急性主动脉 A 型夹层的手术死亡率为 14%～26% [18-20]，这可能与本组患者年龄较为年轻有关。但是比 Bavaria 报道的死亡率要高，Bavaria 等总结 163 例急性主动脉 A 型夹层手术患者的死亡率为 9.8%[21]，Bavaria 报道的全弓置换仅占 5%，而本中心 90.93% 患者行全主动脉弓置换，手术的差异可能是造成死亡率不同的原因。通过多因素危险分析我们发现术前和术后肾功能不全都是早期死亡的危险因素，与既往学者研究结果一致[22]。与主动脉瓣交界悬吊组相比，其它两组的死亡率高，ICU 停留时间最长，可能与患者术后肾功能不全的比例较高有关。术后肾功能不全发生率高与术前肾功能不全的比例较高有关，有学者研究发现术前存在肾功能受损是术后发生急性肾损伤的危险因素[23]，主动脉瓣交界悬吊组的术前肾功能不全的比例最高，因此术后更容易出现肾功能损伤。由于主动脉根部置换的手术难度较高，导致体外循环时间和主动脉阻断时间都比其余两组要长，而主动脉阻断时间延长会增加急性肾损伤的发生率，进一步影响患者生存率[24]。但是在本组的研究中，主动脉根部置换组的死亡率是三组中最低的，可能与患者年龄较年轻，手术容易耐受有关。
通过生存曲线我们发现，1 年内主动脉根部置换组的生存率高于其余两组，但是生存率逐渐下降，5 年的生存率低于其余两组。研究者猜测与主动脉根部置换术后长期服用抗凝药引起的抗凝并发症有关[25]。随着时间的延长，主动脉瓣悬吊组的生存率逐渐表现出优势，尽管免于主动脉瓣中量反流的比例增加，但是并不影响患者的生存率。大部分文献报道的主动脉瓣悬吊免于再次手术率为 80%～90% [26-27]，但是本组研究发现的患者免于因根部病变再次手术率为 100%，也可能随访时间不够，主动脉瓣反流还没有到需要手术处理的程度。有文献指出，虽然主动脉瓣交界悬吊组的再手术率较高，但是远期生存率仍然比根部置换组高[28-29]。本组主动脉根部置换组的年龄较年轻，术前合并症较少，如果需要评估根部修复组和置换组的远期生存率还需要进行均质化后再次进行比较。同时，如果随访时间延长，主动脉瓣悬吊组的生存率是否会出现变化，也需要进一步观察。
综上所述，本中心根据主动脉根部直径、主动脉瓣交界受累程度、主动脉瓣结构选择急性主动脉 A 型夹层累及主动脉根部的处理策略，主动脉瓣交界悬吊，单纯升主动脉置换，主动脉根部置换术，可以达到满意的近远期结果。但是主动脉瓣交界悬吊出现主动脉瓣中量反流的发生率较高，若要评价其超长期疗效还需要进一步研究。
表1 两组患者术前临床资料比较［
/例（%）］
| 变量 | 交界悬吊组（n=403） | 升主置换组（n=95） | Bentall 组（n=175） | P 值 |
| 年龄 | 50.61±9.97 | 49.83±12.28 | 44.07±12.03 | <0.01 |
| 男性 | 287（71.2） | 76（80.0） | 149（85.1） | <0.01 |
| BMI（kg/m2） | 26.1±3.7 | 25.8±3.9 | 24.9±4.3 | <0.01 |
| 高血压 | 325（80.6） | 78（82.1） | 85（48.6） | <0.01 |
| 糖尿病 | 11（2.7） | 1（1.1） | 1（0.6） | 0.18 |
| 马方综合征 | 16（4.0） | 5（5.3） | 43（24.6） | <0.01 |
| 合并根部瘤 | 3（0.7） | 0（0.0） | 22（12.6） | <0.01 |
| 合并冠心病 | 13（3.2） | 4（4.2） | 5（2.9） | 0.83 |
| 射血分数（%） | 60.3±4.8 | 60.1±4.6 | 59.7±6.0 | 0.65 |
| 肾功不全 | 27（6.7） | 4（4.2） | 8（4.6） | 0.47 |
| 肝功不全 | 14（3.5） | 2（2.1） | 6（3.4） | 0.79 |
| De Bakey Ⅰ 型夹层 | 391（97.0） | 79（83.2） | 161（92.0） | <0.01 |
| De Bakey Ⅱ 型夹层 | 12（2.9） | 16（16.8） | 14（8.0） | <0.01 |
| 升主动脉直径 | 43.66±6.19 | 42.32±7.52 | 50.17±10.5 | <0.01 |
| 窦直径 | 39.06±5.11 | 38.27±4.41 | 50.39±6.22 | <0.01 |
| 瓣环直径 | 23.87±2.3 | 23.79±2.82 | 26.31±3.18 | <0.01 |
| 交界受累个数 | <0.01 | |||
| 0 个 | 11（2.7） | 55（57.） | 16（9.1） | |
| 1 个 | 117（29） | 28（29.5） | 25（14.3） | |
| 2 个 | 211（52.4） | 12（12.6） | 98（56.0） | |
| 3 个 | 64（15.9） | 0（0.0） | 36（20.6） | |
| 主动脉瓣反流中量
至大量 |
110（27.3） | 6（6.3） | 173（98.9） | <0.01 |
| 主动脉瓣反流大量 | 2（0.5） | 1（1.1） | 2（11.1） | <0.01 |
| BMI：体重指数 | ||||
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| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
表2 两组患者术中临床资料比较［
/例（%）/中位数（四分位数间距）］
| 变量 | 交界悬吊组（n=403） | 升主动脉置
换组（n=95） |
Bentall 组（n=175） | P 值 |
| 手术时间（min） | 409.01±126.03 | 356.36±105.6 | 405.93±125.96 | <0.01 |
| CPB 时间（min） | 189.87±56.1 | 169.21±57.34 | 202.24±75.89 | <0.01 |
| 阻断时间（min） | 95.35±30.62 | 78.89±25.92 | 105.88±30.53 | <0.01 |
| 停循环时间
（min） |
23.38±6.51 | 22.36±6.94 | 22.06±5.31 | 0.13 |
| 手术方式 | 0.03 | |||
| 全弓置换 | 376（93.3） | 81（85.3） | 155（88.6） | |
| 部分弓置换 | 2（0.5） | 3（3.2） | 11（6.3） | |
| 升主动脉置换 | 25（6.2） | 11（11.6） | 9（5.2） | |
| CABG | 38（9.4） | 5（5.3） | 19（10.9） | 0.31 |
| 股动脉旁路术 | 10（2.5） | 1（1.1） | 7（4.0） | 0.33 |
| 术中失血量（ml） | 950.0（620.0） | 900.0（600.0） | 980.0（580.0） | 0.10 |
| 红细胞（U） | 8.0（6.0） | 8.0（5.0) | 8.0（5.0） | 0.04 |
| 血浆（ml） | 900.0（800.0) | 950.0（760.0） | 900.0（700.0） | 0.87 |
| 血小板（U） | 2.0（2.0） | 2.0（1.0） | 2.0（2.0） | 0.01 |
| CPB：体外循环；全弓置换包括：全主动脉弓+支架象鼻术，杂交全主动脉弓置换；部分弓置换包括：部分主动脉弓置换，次全主动脉弓置换；CABG：冠状动脉旁路移植术 | ||||
下载CSV
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
表3 两组患者术后临床资料比较［
/例（%）/中位数（四分位数间距）］
| 变量 | 交界悬吊组（n=403） | 升主置换组（n=95） | Bentall 组（n=175） | P 值 |
| 院内死亡率 | 49（12.2） | 13（13.7） | 17（9.7） | 0.58 |
| 术后通气时间（h） | 25.48±24.21 | 26.84±28.11 | 24.53±24.5 | 0.15 |
| 延迟拔管 | 20（5.0） | 9（9.5） | 8（4.6） | 0.18 |
| 气管切开 | 8（2.0） | 0（0.0） | 2（1.1） | 0.32 |
| 肾功不全 | 153（38.0） | 25（26.3） | 38（21.7） | <0.01 |
| 血滤 | 49（12.2） | 10（10.5） | 17（9.7） | 0.67 |
| 肝功不全 | 133（33.0） | 22（23.2） | 60（34.3） | 0.13 |
| 持续神经损伤 | 30（7.4） | 6（6.3） | 10（5.7） | 0.73 |
| 脊髓损伤 | 20（5.0） | 4（4.2） | 7（4.0） | 0.86 |
| 心功能不全 | 9（2.2） | 2（2.1） | 6（3.4） | 0.67 |
| 开胸止血 | 11（2.7） | 4（4.2） | 2（1.1） | 0.28 |
| ICU 停留时间（h） | 24（76.0） | 45（66.0） | 35（62.0） | <0.01 |
| 住院时间（d） | 6（14.0） | 4（16.0） | 8（14.0） | 0.60 |
| ICU：重症监护室 | ||||
下载CSV
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
表4 院内死亡多因素分析
| 变量 | OR 值 | 95% 可信区间 | P 值 |
| 术前肾功不全 | 3.38 | 1.16～9.81 | 0.01 |
| CPB 时间 | 1.01 | 1.01～1.02 | <0.01 |
| 术中红细胞用量 | 1.01 | 1.00～1.02 | 0.04 |
| ICU 停留时间 | 0.99 | 0.99～0.99 | 0.01 |
| 开胸止血 | 7.88 | 1.71～36.44 | <0.01 |
| 术后肾功不全 | 3.56 | 1.59～7.99 | <0.01 |
| 术后血滤 | 7.89 | 3.26～19.08 | <0.01 |
| 术后心功能不全 | 12.10 | 1.16～126.45 | 0.04 |
| 住院时间 | 0.95 | 0.92～0.98 | <0.01 |
| CPB：体外循环；ICU：重症监护室 | |||
下载CSV
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
表5 远期死亡多因素分析
| 变量 | OR 值 | 95% 可信区间 | P 值 |
| 年龄 | 1.04 | 1.02～1.08 | <0.01 |
| 术前肾功不全 | 2.83 | 1.11～7.25 | 0.03 |
| ICU 停留时间 | 0.99 | 0.99～0.99 | <0.01 |
| CPB 时间 | 1.01 | 1.01～1.01 | <0.01 |
| 开胸止血 | 4.85 | 1.30～18.07 | 0.02 |
| 术后血滤 | 10.88 | 5.45～21.71 | <0.01 |
| CPB：体外循环；ICU：重症监护室 | |||
下载CSV
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
| 1. | Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278. |
| 2. | Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812. |
| 3. | Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73. |
| 4. | Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517. |
| 5. | Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112. |
| 6. | 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192. |
| 7. | Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090. |
| 8. | 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511. |
| 9. | Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730. |
| 10. | Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937. |
| 11. | Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713. |
| 12. | Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871. |
| 13. | Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844. |
| 14. | Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632. |
| 15. | Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962. |
| 16. | Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739. |
| 17. | Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890. |
| 18. | Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250. |
| 19. | Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81. |
| 20. | Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382. |
| 21. | Bavaria JE, Brinster DR, Gorman RC, et al. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg, 2002, 74(5): S1848-S1852. |
| 22. | 刘正琴, 吴树明, 山东大学, 等. A 型主动脉夹层术后常见神经系统并发症的系列研究. 中国胸心血管外科临床杂志, 2017, 24(3): 211-216. |
| 23. | Schoenrath F, Laber R, Maralushaj M, et al. Survival, neurologic injury, and kidney function after surgery for acute type A aortic dissection. Thorac Cardiovasc Surg, 2016, 64(2): 100-107. |
| 24. | Casselman FP, Tan ES, Vermeulen FE, et al. Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection. Ann Thorac Surg, 2000, 70(4): 1227-1233. |
| 25. | Kunihara T, Neumann N, Kriechbaum SD, et al. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J, 2017, 81(12): 1824-1831. |
| 26. | Kirsch M, Soustelle C, Houël R, et al. Risk factor analysis for proximal and distal reoperations after surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg, 2002, 123(2): 318-325. |
| 27. | von Segesser LK, Lorenzetti E, Lachat M, et al. Aortic valve preservation in acute type A dissection: is it sound? J Thorac Cardiovasc Surg, 1996, 111(2): 381-390. |
| 28. | Castrovinci S, Pacini D, Di Marco L, et al. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis. Eur J Cardiothorac Surg, 2016, 50(2): 223-229. |
| 29. | Gunn TM, Stamou SC, Kouchoukos NT, et al. Techniques of proximal root reconstruction and outcomes following repair of acute type A aortic dissection. Aorta (Stamford), 2016, 4(2): 33-41. |
- 1. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest, 2000, 117(5): 1271-1278.
- 2. Pacini D, Di Marco L, Fortuna D, et al. Acute aortic dissection: epidemiology and outcomes. Int J Cardiol, 2013, 167(6): 2806-2812.
- 3. Fann JI, Glower DD, Miller DC, et al. Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg, 1991, 102(1): 62-73.
- 4. Mazzucotelli JP, Deleuze PH, Baufreton C, et al. Preservation of the aortic valve in acute aortic dissection: long-term echocardiographic assessment and clinical outcome. Ann Thorac Surg, 1993, 55(6): 1513-1517.
- 5. Westaby S, Katsumata T, Freitas E. Aortic valve conservation in acute type A dissection. Ann Thorac Surg, 1997, 64(4): 1108-1112.
- 6. 陈伟丹. 保留主动脉瓣主动脉根部置换术的研究进展. 中国胸心血管外科临床杂志, 2012, 19(2): 189-192.
- 7. Yacoub MH, Gehle P, Chandrasekaran V, et al. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg, 1998, 115(5): 1080-1090.
- 8. 李良鹏, 黄福华, 苏存华, 等. 部分主动脉根部重建术在急性 Stanford A 型主动脉夹层的应用. 中国胸心血管外科临床杂志, 2017, 24(7): 506-511.
- 9. Booher AM, Isselbacher EM, Nienaber CA, et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med, 2013, 126(8): 730.
- 10. Yu CT. The considerations of surgical treatment strategies of acute type a aortic dissection. J Thorac Cardiovasc Surg, 2016, 152(3): 935-937.
- 11. Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg, 2002, 73(3): 707-713.
- 12. Pacini D, Settepani F, De Paulis R, et al. Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study. Ann Thorac Surg, 2006, 82(3): 865-871.
- 13. Ergin MA, McCullough J, Galla JD, et al. Radical replacement of the aortic root in acute type A dissection: indications and outcome. Eur J Cardiothorac Surg, 1996, 10(10): 840-844.
- 14. Halstead JC, Spielvogel D, Meier DM, et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg, 2005, 27(4): 626-632.
- 15. Sabik JF, Lytle BW, Blackstone EH, et al. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg, 2000, 119(5): 946-962.
- 16. Goldfinger JZ, Halperin JL, Marin ML, et al. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol, 2014, 64(16): 1725-1739.
- 17. Movsowitz HD, Levine RA, Hilgenberg AD, et al. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol, 2000, 36(3): 884-890.
- 18. Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type a aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250.
- 19. Kazui T, Washiyama N, Bashar AH, et al. Surgical outcome of acute type A aortic dissection: analysis of risk factors. Ann Thorac Surg, 2002, 74(1): 75-81.
- 20. Olsson C, Hillebrant CG, Liska J, et al. Mortality in acute type A aortic dissection: validation of the Penn classification. Ann Thorac Surg, 2011, 92(4): 1376-1382.
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