保留瓣膜的主动脉根部置换术治疗主动脉根部瘤合并中度以上主动脉瓣反流的中期随访结果  

Midterm outcomes of valve-sparing aortic root replacement in patients with aortic root aneurysm and moderate to severe aortic regurgitation

作　　者：张步升 方亮[1] 戴黄栋 谢晓奕[2] 李伟[1] 孔烨[1] ZHANG Busheng;FANG Liang;DAI Huangdong;XIE Xiaoyi;LI Wei;KONG Ye(Department of Cardiac Surgery,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai,200030,P.R.China;Department of Ultrasound,Shanghai Chest Hospital,Shanghai Jiao Tong 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脏外科,上海200030 [2]上海市胸科医院上海交通大学附属胸科医院心脏超声室,上海200030

出　　处：《中国胸心血管外科临床杂志》2022年第8期1014-1019,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市胸科医院基础研究院内培育项目(2020YNJCM09)。

摘　　要：目的评价保留瓣膜的主动脉根部置换术(valve-sparing aortic root replacement,VSRR)治疗主动脉根部瘤合并中度以上主动脉瓣反流患者的中期随访结果。方法纳入2013年10月—2020年5月期间在上海市胸科医院接受VSRR手术且顺利出院的主动脉根部瘤合并中度以上主动脉瓣反流患者40例,其中男31例、女9例,平均年龄(47.1±13.4)岁。主动脉根部真性动脉瘤30例,夹层动脉瘤10例。3例患者为主动脉瓣二叶畸形,12例患者为马方综合征。心脏彩色超声提示:主动脉瓣中度反流18例,重度反流22例。主动脉瓣环内径(27.0±3.9)mm,窦部最大径(52.3±6.1)mm。结果32例患者行David手术,8例患者行Yacoub手术,其中10例患者同期行主动脉瓣叶修复术。40例患者平均随访12~86(45.7±18.9)个月。随访期内,1例患者因心力衰竭死亡,2例因新发Stanford B型主动脉夹层再次手术,无主动脉瓣再次手术。手术后患者纽约心脏协会心功能分级(1.6±0.5 vs.2.8±0.8)、左心室舒张末期内径[(52.2±7.8)mm vs.(61.4±10.6)mm]和左心室舒张末期容积[(136.0±58.8)mL vs.(193.3±83.9)mL]较术前明显改善(P<0.05)。心脏彩色超声提示:主动脉瓣无反流19例,轻度反流18例,轻中度反流3例,无中度及以上反流。结论VSRR技术治疗主动脉根部瘤合并中度以上主动脉瓣反流患者,避免了人工瓣膜及抗凝相关并发症,且瓣膜反流复发率和再次手术率低,改善了患者生活质量,中期效果满意。Objective To evaluate the midterm effect of valve-sparing aortic root replacement(VSRR)on aortic root aneurysm and moderate to severe aortic regurgitation(AR).Methods The clinical data of patients with aortic root aneurysm and moderate to severe AR undergoing VSRR and surviving from the operation from October 2013 to May 2020 were retrospectively analyzed.There were 31 males and 9 females,with an average age of 47.1±13.4 years.There were 30 patients with true aneurysm of aortic root and 10 patients with dissecting aneurysm of aortic root.There were 3 patients with bicuspid aortic valve,and 12 patients with Marfan syndrome.The AR measured by the echocardiogram was moderate in 18 patients and severe in 22 patients.The average diameter of aortic annulus was 27.0±3.9 mm,and the mean largest diameter of aortic sinus was 52.3±6.1 mm.Results A total of 32 patients underwent David technique and 8 patients underwent Yacoub technique,and 10 patients underwent aortic cusp repair simultaneously.All 40 patients completed the follow-up,and the follow-up period was 12-86(45.7±18.9)months.During the period,1 patient died of heart failure,2 had reoperation due to new-onset Stanford B aortic dissection,and no patients had reoperation related to aortic valve.The postoperative New York Heart Association cardiac function classification(1.6±0.5 vs.2.8±0.8),left ventricular end-diastolic dimension(52.2±7.8 mm vs.61.4±10.6 mm)and left ventricular end-diastolic volume(136.0±58.8 mL vs.193.3±83.9 mL)of the patients were significantly improved compared with preoperative ones(P<0.05).By echocardiography,19 patients had no AR,18 patients had mild AR,3 patients had mild-moderate AR,and no patients had moderate or higher AR.Conclusion In patients with aortic root aneurysm and moderate to severe AR,VSRR technique avoids prosthetic valves and anticoagulation-related complications,has lower rate of AR recurrence and reoperation,and improves the quality of life in the midterm period.

关 键 词：主动脉根部瘤 主动脉瓣反流 保留瓣膜的主动脉根部置换术 主动脉根部重建 主动脉瓣叶修复 

分 类 号：R654.3[医药卫生—外科学]