主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果分析  

Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement:Aorta diameter change,mid-and long-term clinical results

作　　者：周晓辉 关强 刘睿 孙寒松 宋云虎 王水云 许建屏 吕锋 王立清 ZHOU Xiaohui;GUAN Qiang;LIU Rui;SUN Hansong;SONG Yunhu;WANG Shuiyun;XU Jianping;LVFeng;WANG Liqing(Department of Adult Surgery,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]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、成人外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2023年第3期381-388,共8页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较主动脉瓣病变伴升主动脉扩张患者同期行主动脉瓣置换术+升主动脉成形术后升主动脉直径变化及中远期临床结果。方法回顾性分析2010年1月—2017年7月阜外医院外科同期行主动脉瓣置换术+升主动脉成形术41例患者的临床资料,其中男28例、女13例,年龄28~76(53.34±12.06)岁。分别测量术前、术后及末次随访时的升主动脉直径,比较纵切-三明治法(纵切组,23列)和外包裹法(外包组,18例)两种成形手术后的中远期临床结果。结果全组患者无围手术期死亡。纵切组和外包组术前升主动脉直径为[(47.04±3.44)mm vs.(46.67±2.83)mm,P=0.709];术后出院前升主动脉直径为[(35.87±3.81)mm vs.(35.50±5.67)mm,P=0.804];末次随访时升主动脉直径为[(41.26±6.54)mm vs.(38.28±4.79)mm,P=0.113],术前、术后及随访期间两组升主动脉直径横向对比差异无统计学意义,而各自组内纵向对比差异均有统计学意义。全组41例患者术后随访23~108(57.07±28.60)个月,中位随访51.00个月。与出院前相比,全组末次随访时升主动脉直径增长率为–1.50~6.78 mm/年,中位增长率为0.70 mm/年,仅有3例术后年增长率>3 mm/年。结论纵切-三明治法成形和外包裹成形两种术式均能有效缩小升主动脉直径,两种术式在成形效果上无明显差异,且中长期随访结果满意。Objective To assess mid-and long-term outcomes and share our clinical method of reduction ascending aortoplasty(RAA)in adult patients undergoing aortic valve replacement(AVR).Methods We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017.There were 28 male and 13 female patients aged 28-76(53.34±12.06)years.Twenty-three patients received AVR+RAA using the sandwich technique(a sandwich technique group),while other 18 patients received AVR+ascending aorta wrap(a wrapping technique group).Ascending aorta diameter(AAD)was measured by echocardiography or CT scan preoperatively and postoperatively.Results There was no perioperative death.The mean preoperative AAD in the sandwich technique group and the wrapping technique group(47.04±3.44 mm vs.46.67±2.83 mm,P=0.709)was not statistically different.The mean postoperative AAD(35.87±3.81 mm vs.35.50±5.67 mm,P=0.804),and the mean AAD at the end of follow-up(41.26±6.54 mm vs.38.28±4.79 mm,P=0.113)were also not statistically different between the two groups.There were statistical differences in AAD before,after operation and at follow-up in each group.All 41 patients were followed up for 23-108(57.07±28.60)months,with a median follow-up of 51.00 months.Compared with that before discharge,the AAD growth rate at the last follow-up was–1.50-6.78 mm/year,with a median growth rate of 0.70 mm/year,and only 3 patients had an annual growth rate of above 3 mm/year.Conclusion Mid-and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

关 键 词：主动脉瓣置换术 升主动脉成形术 升主动脉扩张 三明治法成形术 外包裹成形术 

分 类 号：R654.2[医药卫生—外科学]