瓣环加固改良Yacoub术在主动脉根部瘤患者中的应用  

Modified Yacoub technique with aortic annuloplasty in patients with aortic root aneurysm

作　　者：张步升 赵乃时 杨天阳 孔烨[1] ZHANG Busheng;ZHAO Naishi;YANG Tianyang;KONG Ye(Department of Cardiac Surgery,Shanghai Chest Hospital,Shanghai Jiaotong University,Shanghai,200030,P.R.China)

机构地区：[1]上海市胸科医院上海交通大学附属胸科医院心外科

出　　处：《中国胸心血管外科临床杂志》2020年第3期332-335,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评价瓣环加固改良Yacoub术治疗主动脉根部瘤伴瓣环扩大患者的可行性和安全性。方法回顾性分析2017年11月至2019年1月我科收治的6例主动脉根部瘤伴瓣环扩张患者行瓣环加固改良Yacoub手术的临床资料,其中男5例、女1例,平均年龄(54.1±12.3)岁。术前心功能分级(NYHA)Ⅱ级3例,Ⅲ级3例。2例患者为主动脉瓣二叶畸形,无马方综合征。心脏彩超:主动脉瓣反流,轻度1例、中度1例、重度4例。主动脉瓣环(27.8±1.9)mm,主动脉根部最大径(49.8±3.7)mm。6例患者均行瓣环加固改良Yacoub手术,其中5例同期行主动脉瓣叶修复成形术。结果6例患者均康复出院,无二次开胸止血、脑梗死、急性肾功能衰竭等并发症。手术体外循环时间(204.6±13.5)min,主动脉阻断时间(168.0±17.1)min,机械通气时间(21.3±19.5)h,住ICU时间(67.8±62.2)h。术后随访(12.8±4.7)个月,患者心功能较术前明显改善,心功能分级Ⅰ级4例、Ⅱ级2例;主动脉瓣无反流2例,轻度反流4例。患者左心室舒张末期容积较术前明显缩小[(118.6±20.4)mL vs.(169.1±58.4)mL,P<0.05]。结论瓣环加固改良Yacoub术治疗主动脉根部瘤伴瓣环扩张是安全有效的,近中期效果满意。Objective To evaluate the feasibility and safety of modified Yacoub technique with aortic annuloplasty in the patients with aortic root aneurysm and dilatation of aortic annular base.Methods We performed a retrospective review of 6 patients with aortic root aneurysm undergoing modified Yacoub technique with aortic annuloplasty from November 2017 to January 2019.There were 5 males and 1 female,with a mean age of 54.1±12.3 years.The preoperative cardiac function of 3 patients was in New York Heart Association(NYHA)classⅡand the other 3 patients were in classⅢ.There were two patients with bicuspid aortic valve,and no Marfan syndrome.There was aortic regurgitation in the patients measured by the echocardiogram,1 in mild aortic regurgitation,1 in moderate aortic regurgitation,and 4 in severe aortic regurgitation.The diameter of aortic annular base was 27.8±1.9 mm,and the largest diameter of aortic root was 49.8±3.7 mm.Six patients underwent modified Yacoub technique with aortic annuloplasty,including 5 patients who underwent aortic cusp repair at the same time.Results All 6 identified patients survived.There was no severe complication(bleeding,stroke,or acute renal failure).The cardiopulmonary bypass time was 204.6±13.5 min,aortic cross-clamping time 168.0±17.1 min,mechanical ventilation time 21.3±19.5 h,ICU stay time 67.8±62.2 h.The follow-up time ranged from 4 to 18 months with an average time of 12.8±4.7 months.Patients'cardiac function improved postoperatively with four patients in NYHA classⅠand two patients with classⅡ.Two patients had no aortic valve regurgitation,four patients had mild regurgitation.Left ventricular end diastolic volume decreased significantly(118.6±20.4 mL vs.169.1±58.4 mL,P<0.05).Conclusion The modified Yacoub technique with aortic annuloplasty is effective and safe for the patients with aortic root aneurysm and dilatation of aortic annular base,and the early-and midterm outcomes are satisfactory.

关 键 词：主动脉根部瘤 保留瓣膜的主动脉根部置换术 改良Yacoub术 主动脉瓣环成形术 

分 类 号：R654.2[医药卫生—外科学]