改良David技术在急性A型主动脉夹层窦部成形中的应用

Application of modified David technique to aortic sinus repair in acute type A aortic dissection

目的总结改良的David技术在急性A型主动脉夹层窦部成形中的应用。方法2018年3月至2018年9月,应用改良David技术行急性A型主动脉夹层根部重塑,完成主动脉窦部成形共19例,男13例,女6例;年龄(50.42±15.37)岁(45~67岁);体质量(60.32±25.18)kg(45~112 kg)。单窦(无冠窦)成形15例,双窦成形(无冠窦+右冠窦+冠状动脉移植)2例,左冠窦弗罗里达袖(Florida sleeve)技术处理加双窦成形(无冠窦+右冠窦+冠状动脉移植)1例,单窦(无冠窦)成形+主动脉瓣置换1例。全弓替换+支架象鼻13例,半弓或次全弓替换3例。结果本组无死亡。体外循环(193.27±32.46)min(176~245 min),主动脉阻断(122.36±18.57)min(105~187 min),手术历时(7.63±1.31)h(6.5~11.0 h)。机械通气(48.27±34.73)h(18~122 h),ICU滞留(5.35±2.62)天(2~10天),术后住院(12.63±3.25)天(7~22天)。术中无延迟关胸,术后无二次开胸,发生一过性房室传导阻滞1例,暂时性神经功能障碍5例。随访6个月,超声心动图及CTA随访无主动脉瓣关闭不全,无残留夹层。结论改良David技术在急性A型主动脉夹层主动脉根部窦部成形中的应用效果确实,手术技术要求相对简单,值得推广。

Objective To summarize the effect of modified David technique on acute type A aortic dissection sinus formation.Methods From March 2018 to September 2018,modified David technique was applied to aortic sinus remodeling in acute A-type aortic dissection in 19 patients,13 males and 6 females.The age was 45-67(50.42±15.37)years old and the weight was 45-112(60.32±25.18)kg.Single sinus(noncoronary sinus)was repaired in 15 cases,double sinus formation(noncoronary sinus+right coronary sinus+coronary artery transplantation)in 2 cases,left sinus Florid sleeve technical treatment plus double sinus formation(noncoronary sinus+right coronary sinus+coronary artery transplantation)in 1 case,Single sinus(noncoronary sinus)repaired and aortic vavle replacement in 1 case.Frozen elephant trunk and total arch replacement in 13 cases,hemiarch replacement in 3 cases.Results There were no deaths in this group.The cardiopulmonary bypass time was 176-245(193.27±32.46)minutes,the aortic cross clamp time was 105-187(122.36±18.57)minutes,and the operation time was 6.5-11.0(7.63±1.31)hours.The mechanical ventilation time was 18-122(48.27±34.73)hours,the intensive care unit stay time was 2-10(5.35±2.62)days,and the postoperative hospital stay was 7-22(12.63±3.25)days.There was no delayed sternal closure during operation,and there was no secondary thoracotomy after operation.One patient developed a transient advanced atrioventricular block.Transient neurological dysfunction was observed in 5 patients.All patients were followed up for more than half a year.The color Doppler echocardiography and computed tomography angiograph(CTA)showed no aortic regurgitation or residual dissection.Conclusion The application of modified David technique in the remodeling of aortic root sinus in acute type A aortic dissection is an effective technique with relatively simple process,which is worth promoting.