扩大主动脉外膜内翻并人工血管端翻转吻合处理急性A型主动脉夹层根部的近期效果

Short-term effects of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection

目的评估应用扩大主动脉外膜内翻并人工血管端翻转吻合处理急性A型主动脉夹层根部的近期治疗效果。方法 2019年11月—2020年7月大连市中心医院心脏大血管外科采用扩大主动脉外膜内翻并人工血管端翻转吻合完成28例急性A型主动脉夹层患者根部处理,其中男19例、女9例,年龄(60.11±11.11)岁。将升主动脉内膜修剪至窦管交界上方5 mm处,升主动脉外膜沿3个主动脉瓣交界纵行剪至预留内膜缘处呈3部分,扩大外膜内翻连续缝合,无冠窦缝合于瓣环上,左、右冠窦缝合于冠状动脉开口上方。吻合端人工血管翻转插入主动脉腔内,翻转人工血管缘5 mm进针于主动脉窦管交界平面连续缝合。结果 28例患者无手术死亡。无难治性根部出血、根部残余假腔、根部扩张、吻合口血肿等并发症。所有患者随访期间均无再发胸背部疼痛症状,复查CT血管造影,结果较出院时无明显变化。出院时22例主动脉瓣膜无反流的患者,仅1例(4.55%)出现轻度反流。6例主动脉瓣轻度反流者中,反流消失率50.0%(3/6)。结论扩大外膜内翻并人工血管端翻转吻合处理主动脉夹层根部,能消除根部残存夹层、防止吻合口出血、重建和加固主动脉夹层的根部结构、恢复根部功能、预防根部的可能扩张,近期效果满意。

Objective To evaluate the short-term therapeutic effect of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of acute type A aortic dissection(ATAAD). Methods From November 2019 to July 2020, 28 patients with ATAAD were treated by extended adventitial inversion with graft eversion anastomosis technique in the Department of Cardiovascular Surgery, Dalian Municipal Central Hospital, including 19 males and 9 females, aged 60.11±11.11 years. The intima of the ascending aorta was trimed to 5 mm above the sinotubular junction. The adventitia of the ascending aorta was longitudinally cut to the reserved intima margin along the junction of the three aortic valves. The extended adventitial inversion was sutured continuously, no coronary sinus was sutured over the aortic annulus, and the left and right coronary sinus was sutured above the coronary ostium. The anastomotic graft was everted and inserted into the aortic lumen, and the everted graft was continuously sutured at the level of sinotubular junction which was 5 mm away from the edge of graft. Results There was no intraoperative death, intractable root hemorrhage, residual root false lumen, root dilatation, anastomotic hematoma or other complications. There was no recurrence of the pain in the back of all patients, and the results of the CT angiography were not significantly changed. In22 patients with no regurgitation, only 1(4.55%) patient had a mild regurgitation. In 6 patients with mild aortic regurgitation, the disappearance rate of regurgitation was 50.0%(3/6). Conclusion The treatment of extended adventitial inversion with graft eversion anastomosis technique in the root treatment of aortic dissection eliminates the residual dissection at the root. The anastomotic hemorrhage is prevented, the root structure of aortic dissection is reconstructed and strengthened, the root function is restored, and the possible expansion of the root is prevented. The short-term results are satisfactory.