保留瓣叶的主动脉根部置换术近期疗效

目的 评价使用保留瓣叶的主动脉根部置换术(David手术)治疗主动脉根部瘤、升主动脉瘤和急性夹层分离的近期疗效.方法 2005年5月至2007年1月10例主动脉瘤病人行保留瓣叶的主动脉根部置换术,其中男9例,女1例.年龄24～64 岁,平均(42.9±12.7)岁.比较其术前、术后心功能、左心室直径和主动脉瓣反流程度的变化.结果 无手术死亡和严重并发症发生.体外循环(174.0±41.2)min,主动脉阻断(132.8±35.7)min,深低温停循环3例.术后随访9～17 个月,平均(12.6±2.8)个月,术后心功能较术前明显改善,NYHA心功能分级从术前2.7±0.48到术后1.80±0.63(P＜0.05).左心室射血分数(LVEF)从术前0.62±0.10增加到术后0.64±0.14(P＞0.05).左心室腔明显缩小,左心室舒张末直径(LVEDD)从术前(62.00±13.58)mm缩小到术后(49.9±13.59)mm(P＜0.05),左心室收缩末直径(LVESD)从术前(41.8±10.97)mm缩小到术后(32.8±12.41)mm(P＜0.05).术后主动脉瓣反流程度明显减轻,从术前3.00±0.82下降到术后1.40±0.84(P＜0.05).结论 保留瓣叶的主动脉根部置换术治疗主动脉根部瘤、升主动脉瘤和急性夹层分离的近期疗效满意.

Short-term follow-up of valve-sparing aortic root replacement

Objective To review the short-term results of valve-sparing operations in patients with aortic root aneurysm,ascending aortic aneurysm,and acute ascending aortic dissection. Methods From May 2005 to January 2007,ten patients were underwent David procedure.There were 9 males and 1 female with the age from 29 to 51 (average 42.9±12.7)years.The data of the cardiac function,the diameters of left ventricular and the degree of aortic valve regurgitation were collected before and after operation.Results There was no operative mortality and major morbidity.The average CPB time was (174.0±41.2) minutes,and the aortic cross-clamp time (132.8±35.7) minutes.During a mean follow-up of 12.6 month(9 to 17 month),the heart function of NYHA classification was improved significantly from 2.7±0.4 preoperatively to 1.8±0.6 postoperatively (P＜0.05).The preoperative and postoperative LVEF were 0.62±0.10 and 0.64±0.14,respectively (P＞0.05).The dimensions of LV cavity decreased significantly.The aortic valve regurgitation decreased significantly from 3.0±0.8 preoperatively to 1.4±0.8 postoperatively (P＜0.05).Conclusion Aortic valvesparing operations have provided satisfactory short-term outcomes for aortic root aneurysm,ascending aortic aneurysm and dissection.