保留主动脉瓣的根部替换术在急性A型主动脉夹层患者中的应用

Application of valve-sparing root replacement operation(David procedure) in patients with acute type A aortic dissection

目的探讨保留主动脉瓣的根部替换术(David手术)对于急性A型夹层合并主动脉瓣关闭不全的患者其临床疗效研究。方法从2016年至2017年,8例急性主动脉A型夹层患者在我院行了David手术,均行David I手术。患者的平均年龄为49±6岁,全部为男性。1名患者进行了单纯David手术,1例患者进行了半弓替换,2例患者进行了杂交全主动脉弓置换,其余4名患者进行了全弓替换。平均随访时间为24±6月。观察David手术治疗主动脉A型夹层患者的临床效果。结果本组患者均痊愈出院,无30天内死亡及随访期间死亡;术中体外循环时间141~305(189±37)min;心肌阻断时间111~219(144±37)min,术后8例患者随访时间为24~49(21±13)月,随访期间无患者需再次手术及死亡,主动脉瓣无反流3例、少量反流4例、中量反流1例。结论David手术为合并主动脉瓣关闭不全的年轻主动脉夹层患者提供了一个具有挑战性的治疗选择。目前我们的数据表明这一方法是安全可行的。对于有经验的心脏中心这一术式用于治疗急性主动脉夹层患者,其近中期瓣膜相关事件很少见,主动脉瓣功能在近期随诊中表现稳定。

Objective To explore the clinical effect of valve-sparing root replacement operation (David procedure) in patients with acute type A dissection combined with aortic insufficiency. Methods From January 2016 to July 2017, 8 patients with acute aortic A-type dissection underwent David surgery in our hospital, all underwent David I procedure. The average age of the patients was 49±6 years old, all patients were male. One patient underwent a David procedure, one patient underwent a semi-arch replacement, two patients underwent a hybrid aortic arch replacement, and the remaining four patients underwent a total aortic-arch replacement. The mean follow-up time was 24±6 months. We observed the clinical effect of David procedure in the treatment of acute type A dissection. Results All patients in this group were recovered and discharged from hospital and no patient died within 30 days and during follow-up. The intraoperative cardiopulmonary bypass time was 141-305 (189±37) min. The crossclamping time was 111-219 (144±37) min. The follow-up time of patients was 24-49 (21±13) months. No patients needed reoperation and died during follow-up. There were 3 cases without aortic valve insufficiency, 4 cases with mild aortic valve insufficiency, and 1 case with moderate aortic valve insufficiency. Conclusion David procedure offers a challenging treatment option for young aortic dissection patients with aortic regurgitation. Our data now shows that this method is safe and feasible. In an experienced cardiac center, this procedure can be used for the treatment of patients with acute aortic dissection, the immediate-term valve-related events are rare, and aortic valve function is stable in recent follow-up.