摘要
目的总结既往主动脉瓣置换术(aortic valve replacement,AVR)后二次主动脉根部置换术的手术策略,并分析早期和中期临床结果。方法2013年4月—2020年1月,75例既往行AVR的患者于北京阜外医院行二次主动脉根部置换术,其中男54例、女21例,平均年龄(56.4±12.7)岁。14例患者行急诊手术,61例行限期手术。二次根部置换术的指征包括38例主动脉根部瘤、30例主动脉夹层累及根部、2例主动脉根部假性动脉瘤、2例人工瓣膜心内膜炎合并根部脓肿、3例白塞病伴根部毁损。采用Kaplan-Meier生存曲线和log-rank检验评估随访期间的生存率和免于主动脉事件发生率。结果手术操作包括45例保留人工瓣膜的主动脉根部置换术、26例Bentall手术和4例Cabrol手术。手术死亡率为1.3%(1/75)。5例患者出现了复合临床终点,包括1例手术死亡、1例卒中和3例急性肾功能损伤需血液透析。74例存活患者均得到有效随访,平均随访时间为0.5~92.0(30.3±25.0)个月。随访期间发生4例死亡,1年、3年和6年生存率分别为97.2%、91.4%和84.4%。2例患者发生主动脉事件,1年、3年和6年免于主动脉事件发生率分别为98.7%、95.0%和87.7%。急诊手术和限期手术患者之间生存率与免于主动脉事件发生率差异无统计学意义。结论二次主动脉根部置换术可以治疗AVR术后出现的各种主动脉根部病变,并能取得较好的近期和中期临床结果。
Objective To summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement(AVR),and analyze the early and mid-term outcomes.Methods From April 2013 to January 2020,75patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital.There were 54 males and 21females with a mean age of 56.4±12.7 years.An emergent operation was performed in 14 patients and an elective operation in 61 patients.The indications were aortic root aneurysm in 38 patients,aortic dissection involving aortic root in 30patients,root false aneurysm in 2 patients,prosthesis valve endocarditis with root abscess in 2 patients,and Beh?et’s disease with root destruction in 3 patients.The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test.Results The operative procedures included prosthesis-sparing root replacement in 45 patients,Bentall procedure in 26 patients,and Cabrol procedure in 4 patients.Operative mortality was 1.3%(1/75).A composite of adverse events occurred in 5 patients,including operative death(n=1),stroke(n=1),and acute renal injury necessitating hemodialysis(n=3).The follow-up was available for all 74survivors,with the mean follow-up time of 0.5-92.0(30.3±25.0)months.Four late deaths occurred during the follow-up.The survival rate at 1 year,3 years and 6 years was 97.2%,91.4%and 84.4%,respectively.Aortic events developed in 2patients.The rate of freedom from aortic events at 1 year,3 years,and 6 years was 98.7%,95.0%and 87.7%,respectively.There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients.Conclusion Reoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR,with acceptable early and mid-term outcomes.
作者
顿耀军
史艺
郭宏伟
魏波
魏以桢
钱向阳
孙晓刚
于存涛
DUN Yaojun;SHI Yi;GUO Hongwei;WEI Bo;WEI Yizhen;QIAN Xiangyang;SUN Xiaogang;YU Cuntao(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第1期113-120,共8页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-036)。
