保留主动脉瓣的主动脉根部成型术在A型主动脉夹层中的应用

Application of aortic rootplasty with preserving aortic valve in type A aortic dissection

目的:总结保留主动脉瓣的主动脉根部成型术在A型主动脉夹层中的应用效果。方法:收集2016年12月至2020年5月,在新乡医学院第三附属医院心胸外科开展的保留主动脉瓣的主动脉根部成型术患者的临床资料,共18例患者,男性11例,女性7例,平均年龄(50.83±10.13)岁,术前诊断:急性Stanford A型主动脉夹层,高血压病,主动脉瓣关闭不全(轻度):6例中度:2例重度:4例于发病后4~24 h,平均(11.42±5.71)h后急诊手术,方法为在深低温全麻体外循环下行保留主动脉瓣的主动脉根部成型术及升主动脉及主动脉弓部置换术加降主动脉腔内覆膜支架置入术。分析保留主动脉瓣的主动脉根部成型术操作程序和手术方法和者围术期临床资料,总结术后随访资料,分析该手术效果。结果:全组18例患者均手术顺利,15例痊愈出院,2例术后发生低心排死亡(病死率11.1%),1例术后大面积脑梗死自动出院;24 h引流量(421.25±92.72)mL,没有二次开胸止血患者,主动脉瓣均关闭良好,无中度以上主动脉瓣关闭不全的并发症出现。术前和术后LVEF、LVEDD差异无统计学意义(P>0.05)、术前和术后主动脉内径值,差异有统计学意义(P<0.05)。随访14例,所有患者存活良好,复查胸腹联合CTA无再发夹层及内漏患者。结论:保留主动脉瓣的主动脉根部成型术在A型主动脉夹层中的临床应用效果满意。

Objective: To summarize the application effect of aortic root plasty with aortic valve preservation in type A aortic dissection. Methods: Collect clinical data of patients undergoing aortic valve-preserving aortic root angioplasty at the Department of Cardiothoracic Surgery of the Third Affiliated Hospital of Xinxiang Medical College from December 2016 to May 2020. A total of 18 patients were male. 11 cases, 7 female cases, age(50.83±10.13)years old, preoperative diagnosis: acute Stanford type A aortic dissection, hypertension, aortic regurgitation(mild): 6 cases moderate: 2 cases severe: 4 cases, emergency surgery 4-24(11.42±5.71) hours after the onset of onset, the method was aortic root plasty with aortic valve preservation under deep hypothermic general anesthesia and cardiopulmonary bypass, ascending aorta and Aortic arch replacement plus stent graft placement in the descending aorta. Analyze the operating procedures and method of aortic root plasty with aortic valve preservation, as well as the perioperative clinical data of the patients, summarize the postoperative follow-up data, and analyze the effect of the operation. Results: 18 patients in the group were smooth, 15 cases were discharged, and there were 2 cases of low heart death(11.1% mortality rate), and 1 case of large-scale cerebral infarction was automatically discharged, drainage volume was(421.25±92.72)mL 24 hours after operation. There were no patients with secondary thoracotomy to stop bleeding. The aortic valves closed well, and there were no complications of moderate or higher aortic valve insufficiency.Preoperative and postoperative LVEF, there was no statistically significant difference in the end of the left ventricular diastolic(P> 0.05), the difference in intraoperative intraoperative inoperative and postoperative aorticity was statistically significant(P <0.05).14 patients were followed up, all patients were well survive, reviewing the chest-free CTA without re-hair clamping and inner haul patients. Conclusions: The clinical application effect of aortic root plasty with aortic valve preservation in type A aortic dissection is satisfactory.