自体心包主动脉窦成形术治疗急性A型主动脉夹层累及窦部患者的近期疗效分析  

Short-term Efficacy of Aortic Sinus Repair Using a Pericardial Autograft for Patients With Acute Type A Aortic Dissection

作　　者：王尧 卢平方 李华鹏 任荣 庄贤勉 张文 陈枫杰 王湘 李刚 郭宏伟 WANG Yao;LU Pingfang;LI Huapeng;REN Rong;ZHUANG Xianmian;ZHANG Wen;CHEN Fengjie;WANG Xiang;LI Gang;GUO Hongwei(Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen,Shenzhen(518057),Guangdong,China)

机构地区：[1]中国医学科学院阜外医院深圳医院血管外科中心,广东省深圳市518057 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院血管外科中心

出　　处：《中国循环杂志》2022年第12期1228-1232,共5页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程临床与转化医学研究基金项目(2020-12M-C&T-B-059)。

摘　　要：目的:评价自体心包主动脉窦成形术治疗急性A型主动脉夹层累及窦部患者的近期疗效。方法:纳入2021年4月至2022年2月期间在中国医学科学院阜外医院深圳医院接受自体心包主动脉窦成形术的18例急性A型主动脉夹层累及窦部患者,其中男性16例、女性2例,平均年龄(58.17±16.06)岁。对患者临床资料进行回顾性分析。结果:全部患者无围术期死亡。术中体外循环时间(229.22±56.88)min,主动脉阻断时间(170.44±48.21)min,深低温停循环时间(20.06±4.72)min。术后机械通气时间(78.29±100.45)h,术后重症监护病房停留时间(220.55±162.46)h,术后住院时间(23.88±7.65)d。平均随访(4.56±3.42)个月,1例患者术后6个月死于严重肺部感染。术前、术后出院前、随访中主动脉窦部直径分别为(38.47±2.80)mm、(36.20±3.28)mm、(36.00±3.27)mm,三者间差异无统计学意义(P>0.05)。术后出院前、随访中主动脉窦部均无夹层残留。术前主动脉瓣大量反流1例、中大量反流2例、中量反流1例、少中量反流1例、少量反流7例、微量反流2例、无反流4例;术后出院前、随访中主动脉瓣均为少量及以下反流。结论:创新性应用自体心包主动脉窦成形术处理累及窦部的急性A型主动脉夹层安全、有效,近期效果满意,远期需进一步随访。Objectives:To evaluate the short-term efficacy of aortic sinus repair using a pericardial autograft for patients with acute type A aortic dissection.Methods:This study included 18 patients,who underwent aortic sinus repair using a pericardial autograft for type A aortic dissection from April 2021 to February 2022.There were 16 males and 2 females,the mean age was(58.17±16.06)years.Short-term efficacy was assessed by cardiopulmonary bypass time,clamp aorta time,circulatory arrest time,mechanical ventilation time,length of intensive care unit(ICU)stay,and length of postoperative hospital stay.The diameter of sinus and aortic regurgitation were assessed before,after operation and during follow-up.Results:There was no postoperative death at 30 d after operation.Cardiopulmonary bypass time was(229.22±56.88)min;clamp aorta time was(170.44±48.21)min;circulatory arrest time was(20.06±4.72)min;mechanical ventilation time was(78.29±100.45)h;ICU stay was(220.55±162.46)h;postoperative hospital stay was(23.88±7.65)d.Mean follow-up time was(4.56±3.42)months.One 79-year-old male patient died of severe lung infection at 6 months after discharge.The preoperative diameter of sinus was(38.47±2.80)mm;postoperative diameter of sinus was(36.20±3.28)mm;the diameter of sinus was(36.00±3.27)mm during follow-up;the differences in sinus diameter among the three timepoints were not statistically significant(P>0.05).There was no residual dissection in the aortic sinus before discharge and during followup.The preoperative aortic regurgitation was as follows:1 case had severe aortic regurgitation,2 cases moderate to severe,1 case moderate,1 case mild to moderate,7 cases mild,2 cases trivial,4 cases none.The aortic valve regurgitation was less than trivial before discharge and during follow-up in this patient cohort.Conclusions:Aortic root repair with a pericardial autograft is safe and effective for patients with acute type A aortic dissection involving the sinus.Short-term efficacy is satisfactory.

关 键 词：急性A型主动脉夹层 主动脉窦 自体心包 外科手术 主动脉瓣关闭不全 

分 类 号：R54[医药卫生—心血管疾病]