A型主动脉夹层保留主动脉瓣手术经验

Aortic valve preservation in type A aortic dissection

目的总结保留主动脉瓣的 A 型主动脉夹层外科治疗的经验。方法收集、分析2009年6月至2014年6月45例 A 型主动脉夹层患者接受保留主动脉瓣的外科手术治疗病历资料。其中，男30例，女15例；年龄36～57岁，平均（45±10）岁。手术方法包括升主动脉置换＋全弓置换＋支架象鼻手术25例、单片技术＋全弓置换＋支架象鼻手术15例，David 技术＋全弓置换＋支架象鼻手术5例，术后随访12个月。结果术中45例主动脉瓣均获得保留。术后并发症包括胸腔积液、心包积液、肝功能不全、肾功能不全各1例。无住院及随访期死亡，随访期无瓣膜相关并发症发生。随诊12个月超声心动图结果示：主动脉瓣反流程度，40例无反流，4例为少量反流，1例为少中量反流。结论A 型主动脉夹层保留主动脉瓣手术早期效果满意。

Objective To explore the experiences of aortic valve preservation techniques in patients with type A aortic dissection.Methods From June 2009 to June 2014,45 patients with type A aortic dissection were treated by aortic valve preservation surgery.There were 30 males and 15 females,the age ranged from 36 to 57 years old with a mean of （45 ±10）years.The operation procedures included ascending aortic artery replacement ＋aortic arch replacement ＋stent-elephant trunk technique in 25 patients,patch technique ＋aortic arch replacement ＋stent-elephant trunk in 15 patients,and David technique ＋aortic arch replacement ＋stent-elephant trunk in 5 patients. The patients were followed up for 12 months.Results Aortic valve were preserved in all patients.Postoperation complication included pleural effusion in 1 case,pericardial effusion in 1 case,hepatic failure in 1 case and renal failure in 1 case.No in hospital and follow up period death occurred .No valve-related complication occured during the follow up.At the end of follow up,no aortic regurgitation was demonstrated in 40 patients,mild regurgitation in 4 patients,and mild to moderate regurgitation in 1 patient.Conclusions The early results of aortic valve preservation operations in type A aortic dissection were favorable .