Bio-Bentall手术治疗复杂主动脉瓣-升主动脉疾病

Bio-Bentall procedure in surgery for complex aortic valve-ascending aortic disease

目的报道应用无支架全主动脉根部生物瓣膜进行全主动脉根部置换术（Bio—Bentall手术）的早、中期临床效果。方法回顾2001年11月到2009年3月病例，317例接受Bio—Bentall手术，男196例，女121例；年龄17～94岁，平均（70．3±10．2）岁，大于75岁的患者97例。均应用Medtronic Freestyle无支架全主动脉根部生物瓣膜进行全主动脉根部置换。203例患者仅行全主动脉根部置换或者主动脉根部置换加升主动脉置换（ARR），114例同期行其他手术（ARR＋），其中冠状动脉旁路移植术82例，主动脉弓置换术36例，二尖瓣成形术11例。结果ARR手术（190±57）min，主动脉阻断（88±27）min。ARR＋手术（282±93）min，主动脉阻断（110±32）min。手术死亡25例，占7．9％。ARR者死亡11例，占5．4％；住ICU（4．9±8．1）天，住院（9．8±8．1）天。ARR组3例紧急行冠状动脉旁路移植手术。术后超声心动图显示跨瓣膜压力阶差低，尤其行间断单纯缝合（非褥式缝合）者压差更小。结论Bio—Bentall手术保留了猪主动脉根部的完整性，不增加围术期和远期病死率，尤其适合小主动脉根部的老年主动脉瓣膜患者。

Objective The stentless full root aortic bioprosthesis has superior hemodynamics. Clinical data of Bio-Bentall procedure using stentless full root bioprosthesis of our center was retrospectively analyzed in this perspective for validation. Methods From November 2001 to March 2009, 317 adult patients （ 196 male and 121 female） underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement. Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement （ ARR）. In 114 patients a variety of concomitant procedures including coronary artery bypass grafting （ n = 32 ） , mitral valve repair（ n = 11 ） and aortic arch replacement （ n = 36 ） were performed. （ ARR ＋ ）. Results Mean patient age was （70.3 ± 10. 2） years （ range 17 - 94 years） , 97 patients were 75 and older at time of procedure. Mean operative time for the ARR was （ 190 ±57 ） rain with a clamp time of 88 - 27 min. Mean operative time for ARR ＋ group was （282 ±93 ） min with an average clamp time of （110 ±32） min. Overall operative mortality was 7.9% （25/317） , for ARR it was 5.4% （ 11/203 ）. Mean ICU stay was （4.9 ±8.1 ） days, mean hospital stay being （9.8 ±8.1 ） days. Necessity for bailout bypass surgery among patients with ARR was low at 1.5 % （ 3/203 ） comparable to stented xenograft implantations. Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used. Conclusion Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/ascending aorta surgery. Though technically a more challenging operation, it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology.