新外膜技术在急性A型主动脉夹层根部修复中的应用

Application of neoadventitia technique in root repair of acute type A aortic dissection

目的:评估新外膜技术在急性A型主动脉夹层根部修复的安全性和有效性。方法:回顾性分析北京安贞医院2019年1月至2022年2月期间外科治疗的94例急性A型主动脉夹层患者。根据主动脉根部处理方式的不同,分为新外膜技术组(58例)和Bentall组(36例),比较两组患者围手术期资料及术后随访结果,分析新外膜技术在急性A型主动脉夹层中的疗效。结果:全部患者无手术死亡,新外膜技术组和Bentall组术后30天病死率分别为3.4%和5.6%( P=0.636)。新外膜技术体外循环时间[(154.3±29.8)min, P<0.001]及主动脉阻断时间[(94.7±20.6)min, P<0.001]均显著缩短,术后主动脉瓣反流情况较术前明显好转(0.33±0.50对1.02±0.80, P<0.001)。术后随访无主动脉根部相关性二次干预发生。两组患者生存率差异无统计学意义( P=0.248)。 结论:新外膜根部修复术是一种安全、可行的急性A型主动脉夹层根部处理方法,近、中期疗效确切。

ObjectiveTo evaluate the safety and efficacy of the neoadventitia technique for root repair in acute type A aortic dissection(ATAAD).MethodsFrom January 2019 to February 2022,a total of 94 patients with ATAAD who underwent surgical treatment in Beijing Anzhen Hospital were retrospectively analyzed.According to the different treatment methods for the aortic root,the patients were divided into the neoadventitia technique group(58 cases)and the Bentall group(36 cases).The perioperative data and postoperative follow-up results of the two groups were compared,and the efficacy of the new adventitia technique in acute type A aortic dissection was analyzed.ResultsThere were no intraoperative deaths.The 30-day mortality was 3.4%and 5.6%in the neoadventitia group and Bentall group,respectively(P=0.636).The cardiopulmonary bypass time[(154.3±29.8)min,P<0.001]and aortic clamp time[(94.7±20.6)min,P<0.001]were significantly shorter in the neoadventitia group,compared with the Bentall group.Aortic regurgitation was significantly improved after the operation(0.33±0.50 vs.1.02±0.80,P<0.001).No aortic root-related secondary intervention occurred during follow-up.There was no significant difference in mortality between the two groups(P=0.248).ConclusionNeoadventitia root repair is a safe and feasible method for the treatment of ATAAD,which has good short-term and mid-term efficacy.