主动脉瓣置换术后患者再次主动脉外科干预47例

Reoperation on aortic disease in patients with previous aortic valve surgery

目的回顾性分析47例主动脉瓣术后再次主动脉外科治疗病例，提高对主动脉瓣术后主动脉疾病再治疗的认识。方法2003年1月至2012年6月，47例患者因主动脉瓣术后接受再次主动脉手术治疗。男38例，女9例，再次手术间隔时间（6．0±3．8）年。行主动脉根部替换14例，升主动脉替换10例，主动脉根部／升主动脉十全弓替换＋象鼻支架置入术21例，全胸腹主动脉替换2例。所有出院患者均行门诊复查和电话随访。结果47例患者中主动脉夹层25例（53％），升主动脉瘤12例（26％），主动脉根部瘤10例（21％）。风湿性心脏病患者升主动脉直径年增长值高于马方综合征患者（P〈0．05）。47例均接受外科手术治疗，术中死亡1例；余患者均出院并随访，随访时间（53．49±33．79）个月，3年生存率83％。结论对马方综合征、风湿性心脏病等主动脉瓣疾病合并主动脉病变要积极干预、严格随访，减少术后主动脉不良事件。

Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve re- placement to deepen the understanding of aortic valve disease. Methods From January 2003 to June 2012, 47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease. 38 male and 9 fe- male, the interval （ 6.0 ±3.8 ） years＇s All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic com- puted tomography. BentalFs procedure were operated on ld patients, total aortic arch replacement with elephant trunk proce- dure on 14 patients, aortic root and aortic arch with elephant trunk procedure on 7 patients, ascending aortic replacement on 10 patients,total thoracic and abdominal aorta replacement on2 cases. All patients were followed by clinic interview or telephone. Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta, each account for 50%, in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve ; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection. Diameter in ascending aorta increased （5.2 ±7. 1 ） mm per year and aortic sinus（3.3 ±3.1 ） mm per year. The value of ascending aortic dilatation per year in patients with rheu- matic disease was higher than patients with Marfan syndrome（ P 〈 0.05 ）. 47 patients were re-operated in fuwai hospital, 1 pa- tients died in operating room because aortic dissection seriously involved right coronary artery. 7 patients have renal insufficien- cy after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 pa- tients stroked and 7 patients had transient brain dysfunciotn. There were no postoperative spinal cord deficits occurred. All pa- tients were followed up, the mean follow up time were（53.49 ±33.79） months. 8 cases were died during follow-up and three- year survival rate was 83%. There were no cases received operation due to aortic disease during follow-up. Conclusion Deep- ening the understanding of aortic valve disease combine ascending aorta changes, especially pay attention to patients with previ- ous aortic valve replacement because of Marfan syndrome and rheumatic disease during follow-up after first operation, all efforts should decrease the occurrence of aortic adverse events in long term.