保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的疗效分析

Results of Valve-sparing Aortic Root Replacement for Patients with Aortic Root Aneurysm

目的评价使用保留主动脉瓣主动脉根部置换术治疗主动脉根部瘤的临床应用疗效。方法 2001年2月至2010年9月阜外心血管病医院对60例主动脉根部瘤患者行保留主动脉瓣主动脉根部置换术,其中男44例,女16例;年龄9～64(37.2±13.0)岁。主动脉夹层15例,升主动脉瘤10例,马方综合征25例,主动脉瓣二瓣化畸形2例。行主动脉根部重建术53例,主动脉瓣瓣叶再植术7例。比较术前、术后心功能及主动脉瓣反流程度等指标。结果全组中无手术死亡和严重并发症发生,呼吸机使用时间中位数为13(2～1 110)h,住ICU时间1～18(2.7±2.5)d。术后复查超声心动图提示:主动脉瓣反流程度均明显减轻,仅3例为中大量反流,其余无反流或微少量反流。术后随访2～122(61.5±35.9)个月,随访56例,失访4例,随访期间死亡9例,生存率83.9%(47/56)。2例因主动脉瓣反流分别于术后13个月和14个月再次入院行主动脉瓣置换术。47例患者心功能较术前明显改善,心功能Ⅰ级35例(74.4%),Ⅱ级8例(17.0%)。免于主动脉瓣中重度反流40例(85.1%)。结论保留瓣叶的主动脉根部置换术治疗主动脉根部瘤的远期疗效满意,瓣膜相关并发症发生率低。

Objective To assess clinical outcomes of valve-sparing aortic root replacement for patients with aortic root aneurysm.Methods From February 2001 to September 2010,sixty patients with aortic root aneurysm underwent valve-sparing aortic root replacement in Fu Wai Hospital.There were 44 male patients and 16 female patients with an average age of 37.2±13.0 years（ranging from 9-64 years）.Fifteen patients had aortic dissection,10 patients had ascending aorta aneurysm,25 patients had Marfan syndrome,and 2 patients had bicuspid aortic valve.Aortic root reconstruction was performed in 53 patients and aortic valve reimplantation was performed in 7 patients.Preoperative and postoperative heart function and degree of aortic insufficiency（AI） were compared.Results Valve-sparing aortic root replacement was performed in all patients.There was no in-hospital death or severe postoperative complications in this group.The median duration of mechanical ventilation was 13 hours（ranging from 2 to 1 110 hours）,while the mean intensive care unit stay was 2.7±2.5 days（ranging from 1 to 18 days）.Postoperative echocardiography showed AI degree was significantly reduced in all the patients.Only three patients had moderate to severe AI,and all the other patients had none or trivial AI.All the patients were followed up for 2-122（61.5±35.9） months.During follow-up,4 patients were lost,9 patients died,and the overall survival rate was 83.9%（47/56）.Two patients underwent aortic valve replacement in the 13 th and 14 th postoperative month respectively because of severe AI.Heart function of 47 patients was significantly improved compared with their preoperative heart function.Thirty-five patients（74.4%）were in New York Heart Association（NYHA） functional classⅠ,and 8 patients（17.0%） were in class II.Forty patients（85.1%）were free from moderate or severe AI.Conclusion Valve-sparing aortic root replacement has satisfactory long-term outcomes for patients with aortic root aneurysm,and valve-related complication rate is low.