114例先天性主动脉瓣二瓣化畸形的外科治疗及中远期随访

目的:总结先天性主动脉瓣二瓣化畸形外科治疗的临床特点及中、远期随访结果,初步探讨手术适应证、方式及应注意问题。方法:本院2003年2月至2007年12月,对先天性主动脉瓣二瓣化畸形患者施行手术治疗共114例,年龄8～91岁,平均(45.6±18.3)岁;男性89例,女性25例。手术均在气管插管全麻低温(28～32℃)体外循环下进行。主动脉瓣机械瓣替换106例,生物瓣替换4例,主动脉瓣成型3例,ROSS术1例,主动脉根部替换1例。同期行升主动脉替换2例、升主动脉包裹2例、冠状动脉旁路移植术1例。结果:术后早期死亡1例,病死率0.88%,死亡原因为心力衰竭。术后并发症8例,其中二次开胸止血1例,低心排出量综合征6例,呼吸功能衰竭1例,均经住院治疗痊愈出院。随访103例,随访时间20～77个月,平均(31±24)个月,非心脏原因死亡1例,无二次手术,所有存活的患者心功能分级均为Ⅰ或Ⅱ级。结论:主动脉瓣二瓣化畸形患者的临床特点具有多样性,在掌握适应证的条件下应根据患者的不同临床特点选择合适的术式。

Surgical management of congenital bicuspid aortic valve in 114 patients and the mid-long term follow-up

Objective：To summarize the clinical characteristics of congenital bicuspid aortic valve and mid-long term results of surgical treatment congenital bicuspid aortic valve.Methods：From February 2003 to December 2007,114 patients underwent surgical treatment.These included 89 men and 25 women,with age ranging from 8-91 years old〔mean,（45.6 ± 18.3） years old〕.All operations were performed with cardiopul-monary bypass（CPB） with mid-low temperature（28 ℃-32 ℃）,including 106 mechanical aortic valve replace-ment,4 bio-aortic valve replacement,3 aortic valve plasty,1 Ross procedure and 1 aortic root replacement.The concomitant surgical management included 2 ascending aortic replacement,2 ascending aortic plasty and 1 coronary artery bypass grafting.Results：1 patient died from heart failure,the mortality is 0.88%.8 cases had complications,including reoperation for excessive postoperative bleeding（2 cases）,respiratory failure（1case） and low cardiac output syndrome（6 cases）.All of the 8 patients were cured.The follow up was 20-77months 〔mean（31 ±24） months〕in103 patients.One patient（0.97%） died of non-cardiac event during the follow-up period and no patients received redo-heart valve replacement.The survivals are in good condition with New York heart association（NYHA） classification Ⅰ-Ⅱ.Conclusion：The clinical characteristics of bicuspid aortic valve is variable and the surgical management should adopt flexible strategy for patients.