保留瓣膜的主动脉根部成形术治疗Ⅰ型主动脉夹层的近期疗效

Early clinical results of valve-sparing aortic root remodeling with patch technique

目的评估U形人工血管片加固病变主动脉窦的保留瓣膜的主动脉根部成形术治疗急性Ⅰ型主动脉夹层的早期疗效。方法 2006年12月至2011年10月,10例急性Ⅰ型主动脉夹层患者实施了U形人工血管片加固病变主动脉窦的保留主动脉瓣的主动脉根部成形术。收集患者术前、术中及术后随访资料。结果无手术死亡及随访死亡病例。术后随访6～24个月,平均(12.5±3.3)个月,术后心功能较术前明显改善,NYHA心功能分级从术前(2.5±0.40)到术后(1.50±0.50)(P<0.05)。左心室射血分数(LVEF)从术前(0.61±0.12)增加到术后(0.66±0.12)(P>0.05)。左心室腔明显缩小,左心室舒张末期直径(LVEDD)从术前(61.00±12.35)mm缩小到术后(48.9±13.41)mm(P<0.05)。10例出院前复查心脏超声未见主动脉瓣关闭不全。结论 U形人工血管片加固病变主动脉窦的保留瓣膜的主动脉根部成形术技术切实可行、安全,早期疗效满意。

Objective To evaluate the short-time results of valve-sparing aortic root repair with U-shaped patch technique in patients with acute typeⅠaortic dissection.Methods Between December 2006 and October 2011,10 patients underwent aortic root remodeling using a U-shaped patch technique,all of the patients had an acute type Ⅰ aortic dissection.Clinical and echocardiographic data were obtained preoperatively,intraoperatively,and early postoperatively,as well as after 6 months or more of follow-up.Results No mortality was observed within the perioperative period and the duration of follow-up.The observation period was（12.5±3.3）months（range,6 to 24 months）.The heart function of NYHA classification was improved significantly from（2.5±0.40）preoperatively to（1.50±0.50）postoperatively（P〈0.05）.The preoperative and postoperative LVEF were（0.61±0.12） and（0.66±0.12）,respectively（P〉0.05）.Left ventricular cavity was significantly reduced,left ventricular end-diastolic diameter（LVEDD）from the preoperative（61.00 ± 12.35）mm,narrowed to postoperative（48.9 ± 13.41）mm（P〈0.05）.10 patients remained unchanged from the early postoperative examinations.Conclusion The valve-sparing aortic root repair with U-shaped patch technique is technically feasible,safe and with satisfying early results.