应用自体心包主动脉窦成形技术治疗急性A型主动脉夹层的近期疗效  

Short-term outcomes of aortic root repair using a pericardial autograft for acute type A aortic dissection

作　　者：畅怡 范舒雅 刘创 孙阳雪 孙晓刚 钱向阳 于存涛 郭宏伟 Chang Yi;Fan Shuya;Liu Chuang;Sun Yangxue;Sun Xiaogang;Qian Xiangyang;Yu Cuntao;Guo Hongwei(Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiovascular Surgery,The First Affiliated Hospital,Zhejiang University College of Medicine,Hangzhou 310003,China)

机构地区：[1]中国医学科学院阜外医院血管外科中心,北京100037 [2]浙江大学医学院附属第一医院心脏大血管外科,杭州310003

出　　处：《中华胸心血管外科杂志》2022年第12期721-725,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

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：目的评价应用自体心包主动脉窦成形技术治疗累及窦部的急性A型主动脉夹层的近期疗效。方法回顾分析北京阜外医院2020年1月至2021年8月间,12例急性A型夹层累及窦部的患者,应用自体心包窦部成形技术行窦部重建。其中男8例,女4例;年龄(49.1±13.0)岁。近期疗效评价包括体外循环时间、主动脉阻断时间、深低温停循环时间、呼吸机辅助时间、ICU时间、术后住院时间;术后并发症及病死率;主动脉窦的变化情况;主动脉瓣的反流情况。结果无术后死亡,体外循环时间(256.4±60.6)min;主动脉阻断时间(195.0±52.5)min;深低温停循环时间平均(19.9±3.6)min。术后呼吸机辅助时间(69.1±72.1)h,ICU时间(143.6±81.7)h;术后住院时间(12.8±4.1)天。中位随访时间13个月(10~21个月)。窦部直径术前(36.7±5.8)mm,术后出院前(35.8±5.1)mm,随访中(35.7±5.9)mm,3个时间段差异无统计学意义(P>0.05)。术前主动脉瓣大量反流2例、中量反流1例、少中量反流3例、少量反流1例、微量反流1例;术后出院前少量反流2例、微量反流2例;随访中少量反流3例、微量反流1例。结论自体心包窦成形技术治疗累及窦部的夹层安全、有效,可减少近端吻合出血,增加耐久性,维持窦部的舒缩功能,近期结果满意,远期需进一步随访。Objective To evaluate the short-term outcomes of aortic root repair using a pericardial autograft for acute type A aortic dissection.Methods Between January 2020 and August 2021,12 patients underwent aortic root repair using a pericardial autograft for type A aortic dissection.There were 8 males and 4 females,aged from 32.0 to 71.0 years,with a mean of(49.1±13.0)years,weight from 40.0 to 100.0 with a mean of(78.6±20.5)kg.Short-term outcomes were assessed by cardiopulmonary bypass time,cross-clamp time,circulatory arrest time,mechanical ventilation time,ICU time,postoperative stay time.The diameter of Valsalva sinus and aortic regurgitation were assessed before,after operation and during follow-up.Results There were no postoperative and follow-up death.Cardiopulmonary bypass time was(256.4±60.6)min,ranging from 182.0 to 243.0 minutes;cross-clamp time was(195.0±52.5)minutes,ranging from 127.0 to 284.0 minutes;circulatory arrest time was(19.9±3.6)min,ranging from 15.0 to 25.0 min;mechanical ventilation time was(69.1±72.1)hours,ranging from 6.4 to 250.3 h;ICU time was(143.6±81.7)h,ranging from 56.9 to 288.0 h;postoperative stay time was(12.8±4.1)days,ranging from 8.0 to 20.0 days.One patient had transient paralysis(8.3%),and one patient needed hemofiltration due to acute kidney failure(8.3%),they all completely recovered before discharge.Follow-up time ranged from 10.0 to 21.0 months,with a median of 13 months.Heart function(NYHA)was I to II degrees.The mean diameter of aortic root was(36.7±5.8)mm(27.0-45.0 mm)preoperatively,(35.8±5.1)mm(25.0-44.8 mm)before discharge,and(35.7±5.9)mm(25.1-44.8 mm)during follow-up,respectively.There was no significant difference between them(P>0.05).The preoperative aortic regurgitation was as follow:severe aortic regurgitation 2,moderate 1,mild to moderate 3,mild 1,trivial 1,none 4;postoperative aortic regurgitation:mild 2,trivial 2,none 8;follow-up aortic regurgitation:mild 3,trivial 1,none 8.Conclusion Aortic root repair with a pericardial autograft is a safe and effectiv

关 键 词：自体心包 主动脉夹层 主动脉窦 主动脉瓣关闭不全 外科手术 

分 类 号：R654.3[医药卫生—外科学]