中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

急性主动脉 A 型夹层主动脉根部处理技术的近远期效果分析

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目的 本研究比较急性主动脉 A 型夹层累及主动脉根部的各种处理方式的早期和远期结果,处理的方式包括:主动脉瓣交界悬吊,升主动脉置换,主动脉根部置换。 方法 收集 2010 年 1 月 1 日至 2015 年 12 月 31 日期间,阜外医院急性主动脉 A 型夹层并累及主动脉根部的手术患者总共 673 例,男性 512 例,女性 161 例,平均年龄(48.8±11.22)岁。主动脉瓣交界悬吊组共 403 例,其中男性 287 例,女性 116 例,平均年龄(50.61±9.95)岁。单纯升主动脉置换组 95 例,男性 76 例,女性 19 例,平均年龄(49.83±12.21)岁。主动脉根部置换组 175 例,男性 149 例,女性 26 例,平均年龄(44.07±11.99)岁。比较主动脉瓣交界悬吊组、升主动脉置换组、主动脉根部置换组患者的术前主动脉瓣反流、术中指标、术后主动脉瓣反流等指标差异。 结果 591 例(87.8%)患者不同程度的主动脉瓣交界受累,主动脉瓣交界悬吊组,升主动脉置换组,主动脉根部置换组的交界轻度、中度、重度受累的比例分别(31.7% VS.87.4% VS.23.4%;52.4% VS.12.6% VS.56%;15.9% VS.0 VS.20.6%), 三组具有统计学差异(P<0.01)。三组的主动脉窦直径分别为:(39.06±5.11)mm,(38.27±4.41)mm,(50.39±6.22)mm,三组具有统计学意义(P<0.01)。三组院内死亡率为:12.2%、13.7%、9.7%,无明显统计学差异(P=0.58)。三组的 5 年生存率分别为 83.06%、81.27%、83.05%,P=0.85,三组 5 年免于中量及以上主动脉瓣反流比例分别为 95.2%、98.6%、100%,P=0.07,三组均无再次行主动脉根部干预。 结论 本中心主动脉瓣交界悬吊、升主动脉置换、主动脉根部置换术近远期结果满意。但是主动脉瓣交界悬吊组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。

Objective The goal of this study was to compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute Type A aortic dissection, including aortic valve (AV) resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement procedure (Bentall). Methods All patients who underwent acute Type A aortic dissection repair between January 2010 and December 2015 at Fuwai Hospital were retrospectively analyzed in our study. This included 673 patients, 512 men and mean age was 48.8±11.22 years. 403, 95, and 175 patients underwent AV resuspension, isolated supracoronary ascending aorta replacement, and the Bentall procedure, respectively. 287 male and 116 female were included in AV resuspensiongroup, and the mean age was 50.61±9.95 years. 95 male and 76 female were included in isolated supracoronary ascending aorta replacement, mean age was 49.83±12.21 years. Bentall group had 149 male and 26 female, the mean age was 44.07±11.99 years. The differences of preoperative aortic insufficiency, intraoperative variables and postoperative aortic insufficiency were compared in the three groups. Results 591 cases (87.8%) had aortic valve commissure involved. The proportion of mild degree, moderate degree, and severe degree in three groups were statistically significant (31.7% VS.87.4% VS.23.4%; 52.4% VS.12.6% VS.56%; 15.9% VS.0 VS.20.6%; P < 0.01). The diameter of aortic sinus in the three groups was (39.06±5.11) mm, (38.27±4.41) mm, (50.39±6.22) mm, respectively, and P < 0.01. The duration of surgery, cardiopulmonary bypass time, cross-clamp time were also statistically significant (P < 0.01). The in-hospital mortality was 11.73% in the whole group. There was no difference among the three groups (12.2%, 13.7%, 9.7%, P = 0.58). 5-year survival rate were similar (83.06%, 81.27% and 83.05%, P=0.85).The 5-year free from over moderate aortic insufficiency rate were 95.2%, 98.6% and 100% respectively, P=0.07. There was no re-do operation for aortic root diseases in the whole group. Conclusion According to aortic root processing strategy in our center, AV resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement can achieve satisfactory results. However, there is higher incidence of aortic insufficiency through AV resuspension. Further study is needed to evaluate its efficacy.

关键词: 主动脉夹层; 主动脉根部; 主动脉瓣; 死亡率

Key words: Aortic dissection; aortic root; aortic valve; mortality

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