白塞病主动脉瓣置换术后瓣周漏患者再次手术的经验

The experience in reoperation of Behcet's disease patient with perivalvular leakage after aortic valve replacement

目的探索心包补片"袖状"重建技术在白塞病合并主动脉瓣环严重毁损再次手术中的应用,总结报道临床应用经验及早期随访结果。方法回顾性分析2012年8月至2022年5月白塞病合并主动脉根部病变的患者资料,共60例患者接受66次主动脉根部手术,其中19例术后瓣周漏的再次手术患者入选研究。其中15例行常规全根置换术,4例主动脉瓣环严重毁损的采用心包补片"袖状"重建技术行全根置换术。查阅病历资料记录人口学及围术期临床资料。出院后电话随访收集资料。结果19例患者中位年龄为39(36,42)岁,其中5例为女性,术后发生瓣周漏距前次手术中位时间间隔为5(3,14)个月。全组无围术期死亡。15例行常规全根置换,5例同期行冠状动脉旁路移植术,术中1例因低心排血量综合征置入体外膜肺氧合,1例因低心排血量综合征置入IABP,1例术后置入永久起搏器。中位随访55.00(29.25,71.25)个月。2例失访,1例术后3年因感染死亡。1例再次出现瓣周漏。2例出现远端吻合口假性动脉瘤再次手术。4例心包补片"袖状"重建者,1例行气管切开,中位随访5.50(5.00,11.25)个月,未观察到瓣周漏及假性动脉瘤,心功能(NYHA分级)均为Ⅰ-Ⅱ级。结论白塞病合并主动脉瓣环严重毁损再次手术中,使用心包补片"袖状"重建技术进行全根部置换术是一种安全、有效的方法。

Objective To introduce the application of sleeve reconstruction with bovine pericardium in the reoperation of Behcet's disease with advanced aortic annulus invasion,and to report our experience and the early outcomes.Methods From August 2012 to May 2022,19 patients with Behcet's disease developed perivalvular leakage after previous surgery underwent aortic root replacement.They were analyzed retrospectively.Fifteen out of 19 cases underwent conventional aortic root replacement,4 cases with advanced aortic annulus invasion underwent sleeve reconstruction with bovine pericardium.The medical records were reviewed.Demographic and perioperative data were collected,which included the aortic crossclamp time,intraoperative RBC consumption,length of ICU stay,and major postoperative complications.Postoperative follow-up was accomplished through telephone visit.Results The median age was 39(36,42)years old.Five were female.The median interval of diagnosis of perivalvular leak from index surgery was 5(3,14)months.There was no perioperative death.Fifteen patients underwent conventional aortic root replacement.One patient had intraoperative ECMO impant due to low cardiac output as well as another one had IABP support.CABG was performed in 5 patients.One patient underwent permanent pacemaker implantation after surgery.The median follow-up time for the 15 patients was 55.00(29.25,71.25)months.Two patients were lost during follow-up.One patient died of infection 3 years after surgery.One patient developed perivalvular leak.Two patient developed distal anastomotic pseudoaneurysm which need reintervention.The median follow-up time for the 4 patients with sleeve reconstruction was 5.5(5,11.25)months.One patient underwent tracheotomy.Perivalvular leakage and pseudoaneurysm were not appreciated.Four patients were in NYHA classⅠ-Ⅱ.Conclusion The sleeve reconstruction with bovine pericardium is safe and effective in reoperation treating patients with Behcet's disease and advanced aortic annulus invasion.