摘要
目的比较应用保留主动脉瓣的主动脉根部再植术（DavidⅠ手术）与主动脉根部复合替换术（Bentall术）两种不同手术方法行急性StanfordA型主动脉夹层根部重建的近期疗效。方法回顾性分析2012年10月至2014年3月，65例因主动脉夹层破口累及Valsalva窦部和／或病因为遗传综合征而接受急诊手术治疗的急性StanfordA型主动脉夹层患者临床资料，男42例，女23例；34例采用DavidⅠ手术、31例行Bentall手术进行主动脉根部重建。比较两组围手术期相关指标、术后近期心功能恢复情况以及术后近期生存情况。结果全部患者无手术死亡，两组住院死亡分别占8．8％和9．7％（P〉0．05），术后并发症发生率分别为25．4％和27．9％（P〉0．05），组间差异均无统计学意义。全部患者均同期行主动脉弓替换及降主动脉支架象鼻手术。DavidⅠ组主动脉阻断时间较Bentall组长[（149±23）min对（124±21）min，P〈0．05]，但两组体外循环时间[（186±77）min对（193±89）min，P〉0．05]和手术时间[（341±137）min对（378±174）min，P〉0．05]差异无统计学意义。与Bentall组相比，DavidⅠ组输血量显著减少[（1180±490）ml对（1790±560）ml，P〈0．05]。所有患者随访（17．6±5．4）个月，DavidⅠ组术后6个月主动脉瓣反流程度为0．6±0．4，1例遗传综合征患者因腹主动脉瘤破裂于术后18个月死亡；Bentall组1例术后9个月因颅内出血死亡，1例术后13个月因感染导致主动脉假性动脉瘤破裂死亡。随访至今，两组生存患者CTA复查均未见吻合口假性动脉瘤形成。Bentall组2例心功能（NYHA）Ⅱ级，其余患者心功能均恢复到Ⅰ级。结论与Bentall手术相比，DavidⅠ手术是一种安全、有效的急性A型主动脉夹层根部重建方式，围术期及早期疗效良好，中远期疗效尚待进一步随访。
Objective To evaluate the safety and efficacy of the valve sparing aortic reimplantation in selected patients with acute type A aortic dissection（AAAD）. Methods From October 2012 to March 2014, 65 AAAD patients with entry tear located in the sinus of Valsalva and/or genetic syndrome underwent emergent operation. Of them, 34 patients had valve sparing aortic reimplantation（ David Ⅰ group）, and 31 patients underwent aortic composite replacement（ Bentall group）. Results No operative mortality was observed in this study. In-hospital mortality （ 8.8 % vs. 9.7 % , P 〉 0.05 ） and morbidity （ 25.4% vs. 27.9%, P 〉0.05 ） were comparable between two groups. All the patients underwent arch replacement and stented elephant trunk implantation concomitantly. Mean cross-clamp time[ （149 ±23 ） min vs. （124± 21 ） min, P 〈 0.05 ] was longer for Da- vid I group, while mean cardiopulmonary bypass time[ （186 ±77） min vs. （193 ±89） min, P 〉0.05 ] and mean operation time[ （341± 137 ） rain vs. （378±174） rain, P 〉 0.05 ]had no significant difference between two groups. The blood transfu-sion was significantly reduced in David Ⅰ group than that in Bentall group[ （1 180 ±490） ml vs. （1 790 ±560） ml, P 〈0. 05 ]. The mean follow-up was（ 17.6 ± 5.4） months（ range, 8 - 26 months）. In David Ⅰ group, one patient with genetic syn- drome died of ruptured abdominal aortic aneurysm 18 months postoperatively. Two late deaths occurred in Bentall group due to intracranial hemorrhage alter 9 months and ruptured infective pseudoaneurysm after 13 months respectively. In David Ⅰ group, average grade of aortic regurgitation 6 months postoperatively was 0.6 ＋ 0.4. At the latest visit, no pseudoaneurysm on anasto- mosis was observed. Besides two patients from Bentall group were in NYHA class Ⅱ, all the other patients presented in NYHA class Ⅰ. Conclusion David Ⅰ aortic root reimplantation can be performed safely and obtain excellent short-term results in se- lected
出处
《中华胸心血管外科杂志》
CSCD
2015年第12期719-724,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
国家“十二五”科技支撑计划（2011BAI11B20）
