一期升主动脉-降主动脉转流治疗主动脉缩窄合并心脏畸形

Treatment of complex coarctation and coarctation with cardiac lesions using an extra-anatomic ascending aorta to descending aorta bypass graft

目的:主动脉缩窄合并其他心脏病手术的方法仍然存在争议。本研究的目的是评估经胸骨正中切口一期升主动脉-降主动脉转流+心脏畸形矫治术治疗主动脉缩窄合并其他心脏畸形的疗效。方法:选择我院于2009年4月至2017年6月,应用经胸部正中切口行升主动脉-降主动脉心包内转流术,同期行合并心脏畸形矫治手术的患者13例,女性3例,男性10例,平均年龄35岁(19～59岁)。其中3例bentall术,8例主动脉瓣置换,1例二尖瓣置换,1例二尖瓣成形术。结果:随访期间无死亡病例,主动脉阻断时间和体外循环时间分别是(81±33) min、(123±47) min。术后上肢血压明显改善(P<0.001),有术前的(159±34) mmHg(1 mmHg=0.133 kPa)将至术后(122±17) mmHg,截止最后一次随访,患者上下肢血压无明显压差。结论:一期升主动脉-降主动脉转流治疗主动脉缩窄合并心脏畸形远期效果显著,可以作为主动脉缩窄合并其他心脏畸形的患者选择此手术方式。

Objective: The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the result after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending to descending aortic bypass and various other cardiac procedures. Methods: Between April 2009 to June 2017, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy. An extra-anatomical ascending to descending aortic bypass for coarctation repair was performed in all patients accompanied by various cardiac procedures(3 aortic root and valve replacement;8 aortic valve replacement;1 coronary artery bypass grafting;1 mitral valve replacement;1 aortic valve replacement and coronary artery bypass grafting;1 mitral and tricuspid valve repair). There were 3 women and 10 men with a mean age of 35 years(range 19-59). Results: there was no death during the follow-up of up to 58 month. The mean aortic cross-clamp and cardiopulmonary bypass times were(81±33) and(123±47)minutes,Upper extremity blood pressure significantly improved(P < 0.001). Mean systolic blood pressure decreased from(159±34)mm Hg preoperatively to(122±17) mm Hg postoperatively.At the last follow-up, blood pressure measured at the upper and lower extremities showed no gradient in any patient, indicating a durable function of the extra-anatomical bypass. Conclusions: Ascending-to-descending bypass can be performed via median sternotomy simultaneously with various cardiac procedures without considerable extension of the procedure. The operative and long-term result are excellent, and this approach can be recommended as the procedure of choice in patients with aortic coarctation and additional cardiac diseases necessitating surgery.