涤纶片加固成形根部重建在急性A型主动脉夹层中的应用

Acute type A aortic dissection：indications for valve sparing aortic root reconstruction

目的探讨对急性A型主动脉夹层患者实施保留主动脉瓣的涤纶片加固成形根部重建的临床效果与中、远期生存率。方法2008年1月至2013年12月98例急性A型主动脉夹层患者实施了保留主动脉瓣的涤纶片加固成形根部重建，对手术情况、术后情况及术后随访资料统计分析。结果术前主动脉瓣反流程度为2．3±0．5。体外循环（217．8±43．1）min，主动脉阻断（142．7±37．4）min，住ICU（11．1±5．7）天，住院（14．3±3．2）天。围手术期死亡8例（8．2％），死因均与主动脉瓣无关，二次开胸的比例为3．1％。随访（19．3±7．6）个月，术后1年生存率90．8％，术后3年免于主动脉瓣原因再次手术的概率97．9％，最后一次随访中患者主动脉瓣反流程度0．5±0．3。结论尽管保留主动脉瓣的主动脉根部重建术依然存在一些风险，但是临床效果满意。

Objective To prove that valve sparing aortic root reconstruction may have an impact on the outcome and lon- gevity of the repair for patients with acute type A aortic dissection. Methods Clinical data of 98 consecutive AAAD patients undergoing the valve sparing aortic root reconstruction were analyzed. The postoperative follow-up and the clinical effect of the procedure were retrospectively analyzed. Results Pre-operative grade of aortic insufficiency was（2.3 ± 0.5 ）, CPB-time was （ 217.8 ± 43.1 ） min, aortic cross clamp time was （ 142.7 ± 37.4 ） rain and stay on ICU （ 1 1. 1±5.7 ） days, while hospitalisa- tion was（ 14.3 ± 3.2） days. 8 patients（8.2% ） died peri-operatively. None of the early deaths were valve-related. Rethoracot- omy rate was 3.1%. All patients followed up （ 19.3± 7.6） （ 6 - 68 ） months. Survival at 1 year was 90.8%. Freedom from val- vular reoperation was 97.9% at 3 years. At last investigation, mean grade of aortic insufficiency for AADA was 0.5 ± 0.3 （0 -3 ）. Conclusion Regardless of the underlying indication, the aortic valve preserving reimplantation technique can be performed with favourable functional results.