再植法保留主动脉瓣的根部替换术的应用  

Application of aortic valve sparing root replacement with reimplantation technique

作　　者：刘宁宁[1] 周子凡[1] 王珺[1] 王龙飞[1] 孙立忠[1] Liu Ningning;Zhou Zifan;Wang Jun;Wang Longfei;Sun Lizhong(Department of Cardiology Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Engineering Research Center for Vascular Prostheses,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京市心肺血管疾病研究所,北京市大血管疾病诊疗中心,北京市大血管外科植入式人工材料工程技术研究中心,100029

出　　处：《中华胸心血管外科杂志》2021年第2期65-71,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：2015年度"扬帆"计划重点医学专业(北京市医管局重点医学专业发展计划)(ZYLX201503);北京学者-孙立忠基金(2013-247)。

摘　　要：目的:总结保留主动脉瓣的根部替换术治疗主动脉根部瘤的临床经验。方法:2017年5月至2019年10月20例主动脉根部瘤患者接受再植法保留主动脉瓣的根部替换术。其中男17例,女3例,年龄(35.6±15.8)岁(12~63岁)。其中马方综合征11例,主动脉瓣二瓣化畸形5例,二次手术1例。术前升主动脉直径(40.6±9.7)mm,主动脉窦直径(52.2±9.2)mm,主动脉瓣环径(27.1±3.6)mm,术前主动脉瓣无反流或轻度反流10例,中度反流5例,重度反流5例。全组患者采用再植法保留主动脉瓣的根部替换术,选择人工血管为:26、28和30 mm直血管(例1、3、6),26和28 mm带窦人工血管(例4、6)。术中行主动脉瓣成形6例,游离缘折叠4例,钙化清除1例,融合脊切除缝合1例。结果:全部患者无住院死亡,无二次开胸止血。术中体外循环(171.0±25.6)min,阻断(134.0±23.2)min。术后复查主动脉瓣无反流12例,轻度反流8例。随访(15.1±9.8)个月(4~33个月)。随访期间主动脉瓣中度反流2例,余患者为无或少量反流。暂无再次手术患者。1例随访期间出现回旋支栓塞,经保守治疗好转。结论:再植法保留主动脉瓣的根部替换术治疗主动脉根部瘤安全有效,早中期随访结果满意,可以避免抗凝相关并发症,适用于年轻患者。Objective:To summarize our clinical experience in the treatment of aortic root aneurysm by aortic valve sparing root replacement.Methods:From May 2017 to October 2019,a total of 20 patients with aortic root aneurysm underwent aortic valve sparing root replacement by reimplantation method.There were 17 males and 3 females,with an average age of(35.6±15.8)years(12-63 years).There were 11 cases of Marfan syndrome,5 cases of bicuspid aortic valve,and 1 case of redo operation.The preoperative diameter of ascending aorta was(40.6±9.7)mm,the diameter of aortic sinus was(52.2±9.2)mm,and the diameter of aortic valve ring was(27.1±3.6)mm.There were 10 cases of no or mild regurgitation,5 cases of moderate regurgitation and 5 cases of severe regurgitation.In the whole group of patients,the root replacement of aortic valve was retained by reimplantation,and the artificial graft were selected as:26,28 and 30mm straight vessels,1,3 and 6 cases,respectively,26 and 28mm artificial graft with valsalva sinus,4 and 6 cases,respectively.During the operation,aortic valve cusp repair was performed in 6 cases,such as plication of the free margin(4 cases),decalcification(1 case)and raphe release(1 case).Results:None of the patients died in hospital or underwent rethoracotomy for hemostasis.During the operation,the duration of CPB time was(171.0±25.6)minutes and the duration of cross-clamp time was(134.0±23.2)minutes.There were 12 cases of aortic valve regurgitation and 8 cases of mild regurgitation.The mean follow-up was(15.1±9.8)months(4-33 months).During the follow-up period,there were 2 cases with moderate aortic regurgitation no need reoperation,while the rest of the patients had no or mild regurgitation.There are no patients undergoing reoperation.During the follow-up,1 patient suffered coronary artery embolism in left circumflex artery and recovered after medicine treatment.Conclusion:Reimplantation with aortic valve sparing root replacement is safe and effective in the treatment of aortic root aneurysm,and the early and mid

关 键 词：保留主动脉瓣的根部替换术 再植法 

分 类 号：R654.2[医药卫生—外科学]