急性主动脉A型夹层主动脉根部处理技术的近远期效果分析  

Three techniques of proximal root reconstruction and long term outcomes following repair of acute type A aortic dissection

作　　者：丘俊涛 于存涛[1] 罗新锦[1] 刘燊 姜文翔 吴进林[1] 张良 QIU Juntao;YU Cuntao;LUO Xinjin;LIU Shen;JIANG Wenxiang;WU Jinlin;ZHANG Liang(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China;Department of Cardiovascular Surgery,Peking University International Hospital,Beijing,102206,P.R.China;Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing,100029,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管外科,北京100037 [2]北京大学国际医院心血管外科,北京102206 [3]北京市心肺血管疾病研究所首都医科大学附属北京安贞医院心血管外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2018年第11期949-955,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81270385);中国医学科学院创新工程(2016I2M1016)

摘　　要：目的比较急性主动脉A型夹层累及主动脉根部的各种处理方式的早期和远期结果。方法收集2010年1月1日至2015年12月31日期间,阜外医院急性主动脉A型夹层并累及主动脉根部的手术患者673例的临床资料,男512例、女161例,平均年龄(48.80±11.22)岁。主动脉瓣交界悬吊组共403例,其中男287例、女116例,平均年龄(50.61±9.95)岁。单纯升主动脉置换组95例,男76例、女19例,平均年龄(49.83±12.21)岁。主动脉根部置换组175例,男149例、女26例,平均年龄(44.07±11.99)岁。比较三组患者的术前主动脉瓣反流、术中指标、术后主动脉瓣反流等指标差异。结果 591例(87.8%)患者不同程度的主动脉瓣交界受累,主动脉瓣交界悬吊组,升主动脉置换组,主动脉根部置换组的交界轻度、中度、重度受累的比例分别为31.7%、52.4%、15.9%,87.4%、12.6%、0.0%,23.4%、56.0%、20.6%,三组差异有统计学意义(P<0.01)。三组的主动脉窦直径分别为(39.06±5.11)mm、(38.27±4.41)mm和(50.39±6.22)mm,三组差异有统计学意义(P<0.01)。三组院内死亡率差异无统计学意义(12.2%vs. 13.7%vs. 9.7%,P=0.58)。三组5年生存率差异无统计学意义(83.06%vs. 81.27%vs.83.05%,P=0.85),三组5年免于中量及以上主动脉瓣反流比例差异无统计学意义(95.2%vs. 98.6%vs. 100%,P=0.07)。三组均无再次行主动脉根部干预。结论本中心主动脉瓣交界悬吊、升主动脉置换、主动脉根部置换术近远期结果满意。但是主动脉瓣交界悬吊组主动脉瓣中量反流的发生率较高,若要评价其超长期疗效还需要进一步研究。Objective To compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute type A aortic dissection, including aortic valve（AV） resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement procedure（Bentall）. Methods All patients who underwent acute Type A aortic dissection repair between January 2010 and December 2015 in Fuwai Hospital were retrospectively analyzed in our study. There were 673 patients with 512 males and 161 females at mean age of 48.80±11.22 years. There were 403 patients as an AV resuspension group（287 males and 116 females at average age of 50.61±9.95 years）, 95 patients as an isolated supracoronary ascending aorta replacement group（76 males and 19 females at average of49.83±12.21 years）, and 175 patients as an AV resuspension group（149 males and 26 females at average of 44.07±11.99 years）. The differences of preoperative aortic insufficiency, intraoperative variables and postoperative aortic insufficiency were compared in the three groups. Results Five hundred ninety-one patients（87.8%） had aortic valve commissure involved. The proportion of mild degree, moderate degree, and severe degree among the three groups were statistically significant（31.7%, 52.4%, 15.9%; 87.4%, 12.6%, 0.0%; 23.4%, 56.0%, 20.6%; P 0.01）. The diameter of aortic sinus in the three groups was 39.06±5.11 mm, 38.27±4.41 mm, 50.39±6.22 mm, respectively, with a statistical difference（P 0.01）. The duration of surgery, cardiopulmonary bypass time, aorta cross-clamp time were also statistically significant（P 0.01）. The in-hospital mortality was 11.73% in the whole group. There was no difference among the three groups（12.2% vs. 13.7% vs.9.7%, P=0.58）. Five-year survival rate was similar（83.06% vs. 81.27% vs. 83.05%, P=0.85）. The 5-year free from over moderate aortic insufficiency rate were 95.2%, 98.6% and 100% respectively, with no statistical difference（P=0.07）. There was no re-do ope

关 键 词：主动脉夹层 主动脉根部 主动脉瓣 死亡率 

分 类 号：R654.3[医药卫生—外科学]