保留主动脉瓣的主动脉根部替换手术临床疗效分析

Therapeutic effect of valve-sparing root replacement on aortic root aneurysm

目的探讨保留主动脉瓣的主动脉根部替换术（David手术）治疗主动脉根部瘤的临床疗效。方法28例主动脉根部瘤患者，行David Ⅰ型手术15例，David Ⅱ型手术5例，改良David Ⅱ手术8例，观察David手术临床疗效。结果本组27例痊愈，1例术后30d死于严重低心排出量综合征；术中体外循环时间94～305（173±45）min；心肌阻断时间84～190（124±34）min。术后25例随访8～90（39±11）个月，1例死亡，行主动脉瓣机械瓣置换手术6例，主动脉瓣无反流10例、少量反流5例、中量反流3例。结论David手术治疗主动脉瓣叶及瓣环大致正常的主动脉根部瘤疗效确切。

Objective To explore the therapeutic effect of valve-sparing root replacement operation （David） on aortic root disease. Methods In 28 patients undergoing David procedure for aortic root aneurysm, 15 were performed David I and 13 were performed David Ⅱ in which 8 were performed modified David Ⅱ. The operation outcome was observed. Results In 28 patients, 27 were cured and one patient died of serious low cardiac output syndrome in 30 days after operation. The mean extracorporeal circulation time was from 94 to 305 （173 ±45） minutes, and the aortic cross clamp time was from 84 to 190 （124±34） minutes. During the foliow-up survey for 8 to 90 （39±11） months in 25 patients, 6 patients underwent mechanical aortic valve replacement, one patient died, 10 patients were not found postoperative aortic regurgitation, 5 patients were found slight regurgitation and 3 moderate regurgitation. Conclusions David procedure is effective for aortic root aneurysm with more or less normal aortic leaflets and valvuar ring.