根部修复术在累及主动脉窦的急性A型主动脉夹层中的应用  

Application of aortic root repair in acute type A aortic dissection with aortic sinus involvement

作　　者：胡诚凯 傅正 顾佳伟[2] 李军[2] 孙勇新[2] 朱铠[2] 赖颢[2] 王春生[2] Hu Chengkai;Fu Zheng;Gu Jiawei;Li Jun;Sun Yongxin;Zhu Kai;Lai Hao;Wang Chunsheng(Department of Chest Surgery,Zhongshan Hospital Xuhui Branch,Fudan University,Shanghai 200020,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院徐汇医院胸外科,上海200020 [2]复旦大学附属中山医院心脏大血管外科,上海200032

出　　处：《中华胸心血管外科杂志》2022年第4期204-209,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82070484);上海市卫生健康委员会基金(20214Y0474)。

摘　　要：目的探讨主动脉根部修复术在累及主动脉窦的急性A型主动脉夹层(acute type A aortic dissection,ATAAD)中的疗效。方法收集2015年1月1日至2016年12月31日期间因夹层累及主动脉窦且主动脉根部直径小于45 mm而行主动脉根部修复术的ATAAD患者临床资料。入选患者分为夹层累及≤1个主动脉窦(A)和累及>1个主动脉窦(B)两组。通过对两组患者术前基线情况、影像学特征和术后结果的比较,分析主动脉根部修复方法在窦部累及的ATAAD中的有效性。结果经过筛选,155例患ATAAD患者纳入研究,其中A组100例,B组55例。两组患者的术前基线情况、住院30天内死亡比例和并发症发生率差异无统计学意义。出院后随访(49.1±14.6)个月,随访期间两组患者的生存率无显著差异(92.0%对89.5%,P=0.61)。两组患者主动脉根部直径与术前相比无明显进行性扩张,A组(38.1±3.6)mm对(37.9±3.5)mm,P=0.92;B组(38.4±4.1)mm对(38.3±3.6)mm,P=0.74.两组患者随访期间的主动脉瓣反流均无明显加重,具有较好的疗效。结论主动脉根部修复技术可尝试用于夹层累及1个以上主动脉窦的ATAAD患者,但长期疗效有待进一步研究。Objective To evaluate the outcomes of aortic root repair in acute type A aortic dissection(ATAAD)with aortic sinus involvement.Methods The clinical data of patients with ATAAD involving the aortic sinus and an aortic root diameter of W45 mm who were treated from January 1,2015,to December 31,2016,were collected.Patients were divided into group A(involvement of one aortic sinus or part of one aortic sinus)and group B(involvement of more than one aortic sinus).The effectiveness of aortic root repair in ATAAD with sinus involvement was analyzed by comparing the preoperative imaging characteristics and postoperative results between the two groups.Results The study cohort comprised 155 patients,including 100 patients in group A and 55 in group B.There were no differences between the two groups in baseline characteristics,aortic root diameter,30-day mortality,and complication rates.During an average follow-up of(49.1±14.6)months,there was no difference between the two groups in the survival rate(92.0%vs.89.5%,P=0.61).The aortic root diameter at follow-up showed no progressive expansion compared with preoperatively in either of the two groups[(38.1±3.6)mm vs.(37.9±3.5)mm,P=0.92,A;(38.4±4.1)mm vs.(38.3±3.6)mm,P=0.74,B];furthermore,there was no difference between the two groups in aggravation of aortic regurgitation.Conclusion Aortic root repair achieves satisfactory medium-term outcomes in ATAAD with more than one aortic sinus involved,but the long-tenn outcomes need to be evaluated.

关 键 词：急性A型主动脉夹层 主动脉根部修复 主动脉窦 

分 类 号：R654.3[医药卫生—外科学]