成人主动脉瓣病变合并主动脉缩窄一期畸形纠正手术

One-stage ascending-to-abdominal aortic bypass with concomitant aortic valve procedures for aortic coarctaflon combined with aortic valve pathology in adult patients

目的评价主动脉瓣病变合并主动脉缩窄一期升主动脉一腹主动脉旁路术＋主动脉瓣手术的效果。方法2009年6月到2017年3月，本中心共28例主动脉瓣病变合并主动脉缩窄患者行一期升主动脉一腹主动脉旁路术＋主动脉瓣置换手术或Bentall手术。男23例，女5例；年龄19～59岁，平均（33．6±11．6）岁。合并冠心病1例，主动脉根部瘤12例。结果所有患者均成功完成一期手术。主动脉阻断和体外循环时间分别为（71±23）min和（113±37）min。平均术后住院时间（15．9±4．9）天，平均手术时间（5．2±4．0）h。收缩压由术前（158±36）mmHg（1mmHg=0．133kPa）降至术后（121±18）mmHg。术后随访3-96个月，无死亡，上、下肢动脉压差与术后比较差异无统计学意义。主动脉-腹主动脉人工血管无并发症发生。结论成人主动脉瓣病变合并主动脉狭窄一期行升主动脉一腹主动脉旁路术加主动脉瓣手术是一种有效的治疗。

Objective This study aims to evaluate the results of one-stage ascending-to abdominal aortic bypass and aor- tic valve replacement for concomitant aortic coarctation with aortic valve pathology. Methods From June 2009 to March 2017, 28 consecutive adult patients（23males and 5 females） with aortic eoarctation combined with aortic valve pathology underwent one-stage ascending-to-abdominal aorta bypass and aortic valve replacement or a Bentall procedure. Age 19 - 59, mean age （ 33.6 ± 11.6 ） years ; 1 case of coronary heart disease and 12 eases of aortic root tumor. Results All patients successfully un- derwent the one-stage procedure. The mean aortic cross-clamp and cardiopulmonary bypass times were （71 ±23 ） and （113 ± 37） mins respectively. The average post-operative hospital stay was （15.9 ± 4.9 ） days and the average operation time was （5.2 ± 4.0）h. Systolic blood pressure decreased from （158 ±36 ）mmHg （1 mmHg = 0. 133 kPa） pre-operatively to （121 ± 18 ） mmHg post-operatively. After the operation, follow-up 3 - 96 months, No deaths or significant gradients between the upper and lower extremities occurred during follow-up. Conclusion Ascending-to-abdominal aortic bypass and concomitant aortic valve procedures are a suitable therapeutic option for severe aortic coarctation combined with aortic valve pathology in adult patients.