升主动脉置换术或成形术治疗主动脉瓣病变合并的升主动脉瘤样扩张

Ascending aortic dilatation combined with aortic valve disease： ascending aortic replacement or aortoplasty

目的 对比分析主动脉瓣病变合并升主动脉瘤扩张在行主动脉瓣置换术（AVR）的同时施行升主动脉置换术（A组）或成形术（B组）的结果,探讨两种方法的临床效果及适应证.方法 A、B两组术前年龄、性别、心功能分级、主动脉瓣病变、左室射血分数等差异均无统计学意义.A组主动脉直径（49.45±3.96）mm,B组（49.31±3.68）mm,差异亦无统计学意义.行AVR后A组常规置换升主动脉,B组纵行切除部分升主动脉壁,缝合后包裹28～30 mm人工血管.结果 A、B两组术后均无死亡.A组主动脉阻断（71.70±17.13）min、体外循环（110.52±27.51）min,均明显大于B组的（57.13±16.32）min（P=0.025）和（97.31±19.46）min（P=0.004）.两组术中及术后输血量、并发症发生率差异无统计学意义.结论 主动脉瓣病变合并升主动脉瘤样扩张,年轻病人主动脉直径≥40 mm时应积极手术处理扩张的升主动脉.升主动脉成形术,同时外包裹人工血管的方法较升主动脉置换术更为简单、安全,但升主动脉壁必须无粥样硬化或溃疡.

Objective The results of Aortic valve replacement （AVR）. Combined with ascending aortic replacement（group A） or aortoplasty （group B） in patients with aortic valve disease and ascending aortic dilatation were analysed to assess the clinical outcomes and respective indications. Methods Among the two groups, the age, gender, NYHA class, types of aortic valve lesions and left ventricular ejection fraction were not different statically. The ascending aortic diameters in group A[（50.41 ±3.71） mm] and group B [（48.29±2.18） mm] were not statically different. Ascending aortic replacement was performed in Group A. A Dacron tube（diameter 28 ～ 30mm） was routinely wrapped around the ascending aorta after aortoplasty in group B. Results There was 1 postoperative death in group B, blood transfusion volume and postoperative complications were not stasticaly different in the two groups. Cardiopulmonary bypass time [（110.52 ± 27.51） min] and aortic across clumping time [（71.70 ± 17.13）min] in group A were significantly longer than that of group B [（97.31 ± 19.46） min,P=0. 004; （57.13 ±19.46） min, respectively. P=0.025]. Conclusion Aortic valve disease, especially bicuspid valve disease often combines with ascending aortic dilatation or aneurysm. In younger patients, ascending aorta should be actively treated surgically when the diameter is equal or more than 40mm. Aortoplasty with external reinforcement of a Dacron tube is simpler and safer than aortic replacement in patient without aortic atherosclerosis or ulceration, and large aneurysm.