自体带蒂心包片在主动脉根部置换术后控制出血的应用

The use of autologous pedical pericardium for control of bleeding after aortic root replacement operation

目的探讨控制主动脉根部置换术后难以控制的出血的方法。方法在8例行主动脉根部置换术的患者中,首先将自体带蒂心包片包绕升主动脉根部,形成一个密闭的腔隙,然后再与右心耳吻合,建立与右心房间的交通。结果8例患者均顺利脱机,无一例术后因出血再次开胸止血。除1例患者因并发Ⅲ度房室传导阻滞而需要放置永久起搏器外,所有患者术后均顺利恢复。出院前8例患者均接受心脏B超检查,均未在升主动脉根部与右心房间发现异常血流信号。结论主动脉根部置换手术后常出现难以控制的出血,采用自体带蒂心包片包绕主动脉根部并形成与右心房的瘘道,可以迅速控制出血,避免反复止血而可能导致的严重并发症甚至死亡的发生。

Objective To report our clinical experience in creating a perigraft to right atrial fistula by using autologous pericardium to control the uncontrollable bleeding after aortic root replace operations. Methods A chamber around the aortic graft was created by suturing a patch of autologous pericardium,and then the perigraft chamber was communicated with the right atrial. Results None of these patients required re - exploration for bleeding and they were discharged from the hospital without complications except one patient needed a permanent pace - maker implantation for three degree A - V block. All 8 patients underwent echocardiographic examination before discharge and no perigraft to right atrial shunt was detected. Conclusion Bleeding after complex aortic root replacement operation is often difficult to control. Creating a perigraft to right atrial fistula can be prompt to control bleeding, avoid happening of severe complication and even death after prolonged operative time.