主动脉缩窄合并瓣膜疾病一期修复手术效果

Surgical outcomes of one stage surgical treatments for adult aortic coarctation associated with cardiac valve disorder

目的:探讨一期升主动脉-腹主动脉转流术+瓣膜矫治手术对成人主动脉缩窄合并瓣膜病的疗效。方法:回顾分析我中心2015年8月至2019年11月,成人主动脉缩窄合并瓣膜病患者共14例,平均年龄(36.9±15.0)岁,合并主动脉瓣病变12例,单纯主动脉瓣病变9例,同时合并三尖瓣病变1例,二尖瓣病变2例;单纯二尖瓣病变2例;14例患者均行升-腹主动脉转流术,同期主动脉瓣置换术8例,主动脉瓣瓣周漏修补术1例,二尖瓣置换术2例,双瓣置换术1例,主动脉瓣置换+二尖瓣成形术1例,主动脉瓣置换+三尖瓣成形术1例。根据患者手术前后上下肢压差,平均压差,出血量,手术时间,呼吸机使用时间评价手术效果。结果:患者均存活,最大压差下降(43.3±18.7)mmHg(1 mmHg=0.133 kPa),平均血压差下降(24.7±14.4)mmHg,差异有统计学意义;术中出血量(1 568.6±742.9)mL,呼吸机使用时间(17.9±8.8) h,术后1例胰淀粉酶(AMY)升高,1例残留轻度高血压,1例心脏骤停ECMO辅助,余无明显并发症,随访(26.0±13.9)个月,CTA检查显示人工血管均畅通,手术效果满意,患者上下肢压差减小,无明显不适。结论:一期升-腹主动脉转流+瓣膜手术对成人主动脉缩窄合并瓣膜病的患者安全、有效、可行。

Objective: To discuss and access the effect of one stage ascending-abdominal aorta bypass graft and cardiac valve surgery for patients with coarctation of the aorta associated with cardiac valve disorder. Methods: Retrospectively analyze 14 cases from August 2015 to November 2019 suffered from valve disorder associated with coarctation of aorta.Aged(35.5±15.2) years, valve problems include aortic disorder in 12 cases(simply aortic valve disorder 9 cases, complicated with tricuspid valve disorder in 1 case, complicated with mitral regurgitation in 2 cases) and 2 case with simply mitral valve disorder. 14 cases all went through ascending-abdominal aortic graft bypass, associated with mechanical aortic valve replacement in 8 cases, repair of periaortic valve leakage in 1 case, mechanical mitral valve replacement in 2 cases, double valves replcement in 1 case, aortic valve replacement +mitral valvuloplasty in 1 case, aortic valve replacement +tricuspid valvuloplasty in 1 case. Each case was operated with more than one valve, replaced or repaired. Evaluate the surgical effect depending on pre-post surgical blood pressure, bleeding volume, operating time, ventilation time and ejection fractions. Results: All 14 cases survived those operations without any complication except 1 case developed increased AMY,1 case left mild hypertension, 1 case suffered cardiac arrest and recovered with ECMO assistance. Max blood pressure gradient drops by(43.3±18.7) mmHg(1 mmHg=0.133 kPa),mean blood pressure gradient drops by(24.7±14.4) mmHg. Blood pressures of all cases but one returned to normal, amount of bleeding during operation is(1 568.6.3±742.9)mL, time of operation is(6.4±1.2)h, ventilation time is(17.9±8.8)h. All cases were followed-up investigated, report of CTA test taken 1 month, 3 months, and 6 months after operation shows that all the vessel grafts were unobstructed, blood flows well in those grafts, surgical effect is satisfying, patients’ blood pressure gradient decreased without any symptom. Conclusions: For patients with valve disorder associated with coarctation of aorta, one stage surgical treatments is a safe and effective therapeutic strategy.