保留主动脉瓣的根部修复技术在StanfordA型主动脉夹层的应用

Valve-preserving aortic root operations for Stanford A aortic dissectionValve-preserving aortic root operations for Stanford A aortic dissection

目的评价保留主动脉瓣的主动脉瓣根部修复技术在StanfordA型主动脉夹层中的应用效果。方法回顾性分析本中心2001年1月至2011年6月间采取保留主动脉瓣的主动脉瓣根部修复技术治疗83例StanfordA型主动脉夹层患者的临床资料，男性63例，女性20例，年龄22-71（47．4±10．9）岁。采取封闭主动脉根部夹层、主动脉瓣交界悬吊加固并于窦管交界上方置换升主动脉的主动脉根部重建术74例，David手术9例。结果全组住院期间死亡7例（8．4％）。随访71例，平均随访（3．4±1．5）年，心功能恢复良好，NYHA分级I级66例、Ⅱ级5例；主动脉瓣轻度反流6例，中度反流2例；无因主动脉根部病变而需再次手术治疗者。结论结合StanfordA型主动脉夹层根部病变的特点，采取保留主动脉瓣的主动脉根部修复技术可取得良好的手术效果。

Objective To evaluate the effectiveness of valve-perserving aortic root operation for Stanford A aortic dissection. Methods Retrospective analysis the clinical data of 83 patients suffered surgical treatment for Stanford A aortic dissection between Jan 2001 and Jun 2011. There were 63 men and 20 women. Patient ages ranged from 22 to 71 years. Preserve the aortic leaflets by using teflon felts for reconstruction of the dissected sinuses, then supracommissural replacement of the ascending aorta was performed （n=74）, reimplantation of the aortic valve as David procedures（n=9）. Results Hospital mortality was 8.4%（n=7）. 71 patients were foUowed up clinically and echocardiagraphically for as long as （3.4±1.5） years. NYHA I grade in 66 cases, Ⅱ grade in 5 cases. Mild aortic valve incompetence in 6 patients, 2 with moderate. There were all freedom from proximal reoperation. Conclusion Valve-preserving aortic root operations in Stanford A dissection can be performed with ade- quate perioperative risk and excellent results.