右心房分流术在主动脉根部手术中的临床应用

Clinical application of right atrial shunt in aortic root operation

目的总结右心房分流术在主动脉根部手术中的应用经验,并评价其安全性和疗效。方法 2007年1月～2011年12月,对26例在我院接受主动脉根部手术治疗的患者,采用残余主动脉血管片或自体心包片缝合包裹人造血管及吻合口,并与右心耳部行吻合,建立与右心房间的交通,将人造血管及各吻合口渗血引流入右心房内。结果全组手术时间(248±56)min,体外循环时间(126±36)min,主动脉阻断时间(78±16)min,术中失血量(321±101)ml,术后第1d心包和纵隔引流量(354±179)ml,术后总引流量(635±232)ml,输入血液制品量(1150±455)ml,术后住院时间(11.8±4.6)d。全组无二次开胸止血,死亡3例。出院前心脏彩超提示主动脉根部与右心房间无血液流动,主动脉CTA显示主动脉根部与右心房间分流通道内有血栓形成。结论右心房分流术操作简单、安全,可以有效减少主动脉根部手术后出血,减少出血相关并发症,显著改善主动脉根部手术的临床效果,值得临床推广应用。

Objective To summarize the clinical experience of right atrial shunt in aortic root operation, and to assess its security and effectiveness. Methods A chamber around the aortic graft was created by suturing residual aortic piece or a patch of autologous pericardium for 26 patients underwent aortic root operation from January 2007 to December 2011, and then the chamber was communicated with the right atrium to drain capillary hemorrhage from the root stoma. Results The operation time was mean （248 ±56） minutes, the cardiopulmonary bypass time was mean （126 ±36） minutes, and the aortic cross clamp time was mean （78 ± 16） minutes. The postoperative pericardial and mediastinal drainage volume was mean （354 ± 179 ） milliliters at the first day, and the total postoperative drainage volume was mean （635 ± 232） milliliters. The blood transfusion volume was mean （ 1150 ± 455） milliliters. The postoperative hospital stay was mean （ 11.8 ± 4. 6） days. No re-thoracotomy for bleeding happened, and only 3 patients died. No blood flow from aortic root to fight atrium was detected by color Doppler echocardiography examination, and thrombosis was found in the shunt passage by aortic computed tomography angiography examination before discharge. Conclu- sion Right atrial shunt is simple and safe. It can reduce bleeding and complications associated with bleeding effectively, and improve the clinic effect markedly in aortic root operation. It should be extended in clinic.