Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement

BackgroundThere are limited data regarding the clinical outcomes of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement (AVR). We aimed to analyze outcomes of reoperative aortic root or ascending aorta replacement after prior AVR.MethodsEighty patients with prior AVR underwent reoperative aortic root or ascending aorta replacement in our hospital. The indications were root or ascending aortic aneurysm in 36 patients, root or ascending aortic dissection in 37, root false aneurysm in 2, prosthesis valve endocarditis (PVE) with root abscess in 2, Behçet’s disease (BD) with root destruction in 3 patients. An elective surgery was performed in 63 patients and an emergent surgery in 17. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test.ResultsThe operative techniques included ascending aorta replacement in 14 patients, ascending aorta replacement with AVR in 3, prosthesis-sparing root replacement (PSRR) in 35, Bentall procedure in 24, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/80). A composite of adverse events occurred in 5 patients, including 1 operative death, 2 stroke and 3 renal failure necessitating hemodialysis. The mean follow-up was 35.5±22.1 months. Five late deaths occurred. The Kaplan-Meier survival at 1 year, 3 years and 6 years were 97.5%, 91.1% and 84.1%, respectively. Aortic events developed in 3 patients. The freedom from aortic events at 1-year, 3-year, and 6-year were 100%, 96.3% and 88.9%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group.ConclusionsReoperative aortic root or ascending aorta replacement after prior AVR could be performed to treat the root or ascending pathologies after AVR, with satisfactory early and midterm outcomes.     

Ascending aortic aneurysm and dissection in young adults with bicuspid aortic valve: Implications for echocardiographic surveillance

Bicuspid aortic valve (BAV) is an independent risk factor for aneurysm and dissection of the ascending aorta. Despite this association, routine imaging of the aorta has not been recommended for patients with BAV. We describe two young men who developed life-threatening aneurysm or dissection of the ascending aorta; one had a normally functioning BAV and the other was 10 years after valve replacement. The pathology of this condition is very similar to that found in the Marfan syndrome. We recommend echocardiographic surveillance of the ascending aorta at regular intervals, and consideration of beta-adrenergic blockade among patients with significant dilation.     

Predictability of aortic dissection as a function of aortic diameter.

The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the time of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6.0 +/- 1.3 cm in group 1 and 6.4 +/- 1.4 cm in group 2; mean +/- SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3.2 +/- 0.8 cm.m-2 and 3.4 +/- 0.7 cm.m-2, respectively; ns). However, the individual diameters showed a pronounced scatter in both groups (range from 3.6 +/- 11.0 cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19 without dissection) and seven patients were treated medically. Emergency surgery was performed in 45/66 patients (all with acute type A dissection) and elective repair in 21/66 (19 without and two with chronic type A dissection). In-hospital mortality was 18% in the emergency group, 5% in the elective group and 57% in the medical group. It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable: acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair and have to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm.     

Surgical Treatment of Ascending Aorta and Aortic Root Aneurysms

Aneurysms of the aortic root and ascending aorta are often due to degenerative disease of media. Aneurysm of the aortic root often affects patients in their second to fourth decades of life, whereas aneurysm of the ascending aorta occurs mostly in the fifth to seventh decades of life. These aneurysms can cause aortic insufficiency, dissection, and/or rupture. Current guidelines recommend surgical treatment when the diameter of the aneurysm exceeds 50 mm. In patients with family history of aortic dissection or with Loyes-Dietz syndrome (a more severe form of Marfan syndrome), surgery should be considered when they are even smaller. Composite replacement of the aortic valve and ascending aorta used to be the standard treatment for patients with aortic root aneurysms. During the past 2 decades, a conservative procedure whereby the aneurysm is replaced with Dacron graft and the aortic valve is preserved has gained widespread use, and the results have been excellent in experienced hands.     

Predictability of aortic dissection as a function of aortic diameter

The role of aortic diameter on the occurrence of type A dissectionwas investigated in 73 patients with dilated ascending aortaat the lime of pre-operative evaluation. Using transthoracicechocardiography for diagnosis and measurements, 54 patientswere identified with type A dissection (group 1) and 19 withoutdissection (group 2). The true mean aortic diameters were identical(6·0±1·3 cm in group 1 and 6·4±1·4cm in group 2; mean±SD; ns) as were the indexed aorticdiameters (ratio of diameter/body surface area; 3·2±0·8cm . m^–12 and 3·4±0·7cm m^–2respectively; ns). However, the individual diameters showeda pronounced scatter in both groups (range from 3·6±11·0cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19without dissection) and seven patients were treated medically.Emergency surgery was performed in 45/66 patients (all withacute type A dissection) andelective repair in 21/66 (19 withoutand two with chronic type A dissection). In-hospital mortalitywas 18% in the emergency group, 5% in the elective group and57% in the medical group. It is concluded that patients with dilated ascending aorta havea substantial incidence of acute dissection. Their clinicalcourse is unpredictable; acute dissection occurs in some, andin others the ascending aorta continues to enlarge without dissection.Because patients with dissection often arrive too late for electiverepair andhave to be operated on as emergencies with a higheroperative risk, we recommend elective surgery before the diameterof the ascending aorta has reached 6 cm.     

Predictability of aortic dissection as a function of aortic diameter

The role of aortic diameter on the occurrence of type A dissectionwas investigated in 73 patients with dilated ascending aortaat the lime of pre-operative evaluation. Using transthoracicechocardiography for diagnosis and measurements, 54 patientswere identified with type A dissection (group 1) and 19 withoutdissection (group 2). The true mean aortic diameters were identical(6·0±1·3 cm in group 1 and 6·4±1·4cm in group 2; mean±SD; ns) as were the indexed aorticdiameters (ratio of diameter/body surface area; 3·2±0·8cm . m^–12 and 3·4±0·7cm m^–2respectively; ns). However, the individual diameters showeda pronounced scatter in both groups (range from 3·6±11·0cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19without dissection) and seven patients were treated medically.Emergency surgery was performed in 45/66 patients (all withacute type A dissection) andelective repair in 21/66 (19 withoutand two with chronic type A dissection). In-hospital mortalitywas 18% in the emergency group, 5% in the elective group and57% in the medical group. It is concluded that patients with dilated ascending aorta havea substantial incidence of acute dissection. Their clinicalcourse is unpredictable; acute dissection occurs in some, andin others the ascending aorta continues to enlarge without dissection.Because patients with dissection often arrive too late for electiverepair andhave to be operated on as emergencies with a higheroperative risk, we recommend elective surgery before the diameterof the ascending aorta has reached 6 cm.     

Surgical techniques. Ascending aorta

Aneurysm and dissection are the most common diseases affecting the ascending aorta. Graft replacement of the ascending aorta is a straightforward cardiovascular procedure with excellent early and late results. When aneurysm or dissection extends into the aortic sinuses or arch, management becomes more complex and may entail replacement of the aortic root, aortic valve, or a portion of the aortic arch using hypothermic circulatory arrest. The optimal root prosthesis depends on several patient- and procedure-related variables. Valve-sparing procedures confer many long-term advantages and should be considered in all cases where the aortic valve leaflets are normal. The Ross procedure, although ideally suited for isolated aortic valve disease in young patients, may be applicable to some patients with combined aortic valve and ascending aortic disease, unless there is evidence of a systemic connective tissue disorder.     

Transfusion in Elective Proximal Aortic Reconstruction: Where Do We Currently Stand?

Aortic procedures are associated with higher risks of bleeding, yet data regarding perioperative transfusion in this patient population are lacking. We evaluated transfusion patterns in patients undergoing proximal aortic surgery to provide a benchmark against which future standards can be assessed. Between June 2014 and July 2017, 247 patients underwent elective aortic reconstruction for aneurysm. Patients with acute aortic syndrome, endocarditis, and/or prior cardiac surgery were excluded. Transfusion data were analyzed by type of operation: ascending aorta replacement ± aortic valve procedure (group 1, n  = 122, 49.4%); aortic root replacement with a composite valve–graft conduit ± ascending aorta replacement (group 2, n  = 93, 37.7%); valve-sparing aortic root replacement (VSARR) ± ascending aorta replacement (group 3, n  = 32, 13.0%). Thirty-day mortality for the entire cohort was 2.02% (5 deaths). Overall, 75 patients (30.4%) did not require any transfusion of blood or other products. Patients in groups 1 and 3 were significantly more likely to avoid transfusion than those in group 2. Mean transfusion volume for any individual patient was modest; those who underwent VSARR (group 3) required less intraoperative red blood cells (RBC) than others. Intraoperative transfusion of RBC was independently associated with an increased risk of death at 30 days.Elective proximal aortic reconstruction can be performed without the need for excessive utilization of blood products. Composite root replacement is associated with a greater need for transfusion than either VSARR or isolated replacement of the ascending aorta.     

A giant post-dissection aneurysm of the ascending aorta in an octogenarian

Aneurysm formation is a well-known complication of untreated long-standing dissection of the aorta. Despite numerous advances in cardiac surgery, intrinsic diseases of the ascending aorta and aortic arch requiring surgical therapy, remain a technical challenge. However, surgery is the only option for effective treatment of ascending aorta aneurysm but carries an increased risk of severe morbidity and mortality, particularly in the elderly. We report on the successful repair of a giant ascending aorta aneurysm due to chronic dissection in an elderly woman with dyspnoea as main symptom.     

Appraisal of transthoracic echocardiography for opportunistic screening of abdominal aortic aneurysm

Abdominal aortic aneurysm is a life threatening disease. Most of the patients diagnosed incidentally because of the asymptomatic nature of this disease. This study aimed to determine the frequency of abdominal aortic aneurysm and evaluate the value of opportunistic screening during transthoracic echocardiography.A total of 5138 patients referred for echocardiographic evaluation for any reason were screened for abdominal aortic aneurysm between November 2014 to July 2019. The aneurysm was defined as an abdominal aorta with a diameter greater than 30 mm, or segmental dilatation of more than 50% of its size in non-dilated parts.The overall frequency of abdominal aortic aneurysm was 2.2% (n = 109) in the study population. Male sex (P < .001), older age (P < .001), presence of diastolic dysfunction (P = .036), hypertension (P < .001), coronary artery disease (P < .001), and hyperlipidemia (P < .001) were associated with abdominal aortic aneurysm. Patients with aneurysm had significantly increased diameters of the aortic trunk (P < .001) and ascending aorta (P < .001), significantly thicker interventricular septum (P < .001) and posterior wall (P < .001), significantly increased end-diastolic diameter (P < .001) and enlarged left atrium (P < .001), and significantly decreased ejection fraction (P < .001). The mostly met criteria for screening abdominal aortic aneurysm in international guidelines was the age of the patients.Based on the results of this study, screening patients over 60 years of age who undergo a transthoracic echocardiography for any reason would be beneficial to detect an asymptomatic abdominal aortic aneurysm in Turkish population.     

Respecting Symptoms in Thoracic Aortic Aneurysm Management: A Case of Symptomatic Necrotizing Granulomatous Aortitis

A 41-year-old woman presented with chest pain of unclear etiology in the setting of a mildly dilated ascending aorta. Computed tomography angiography showed an aorta with an irregular contour and an aneurysm of 4.5 cm. There was no radiographic evidence of rupture or dissection. The patient was taken to the operating room and was found to have severe aortitis with marked localized wall thinning at imminent risk of aortic rupture. Aortic pathology demonstrated necrotizing granulomas of noninfectious etiology. This case illustrates the importance of respecting symptoms in surgical decision making for thoracic aortic aneurysms that may not meet standard interventional criteria.     

Right pulmonary artery occlusion secondary to a dissecting aortic aneurysm

This report describes a case of right pulmonary artery obstruction caused by a dissecting aneurysm of the thoracic aorta. Initial ventilation-perfusion (V/Q) scan revealed no perfusion to the right lung. Lack of right lung perfusion plus other clinical abnormalities led to an initial diagnosis of massive embolism in the right lung. Bilateral pulmonary arteriography of the thoracic and abdominal aorta revealed extrinsic compression of the right pulmonary artery near its origin and the suggestion of an ascending aortic dissection. Subsequent ascending aortography and computed tomography (CT) confirmed a dissection of the ascending aorta. Aortography in the true lumen of the aorta revealed trivial aortic insufficiency. These diagnostic procedures confirmed the presence of an acute dissecting aneurysm of the ascending aorta that caused compression of the right pulmonary artery. The finding of a massive unilateral segmental defect with normal ventilation upon lung scanning does not always ensure a diagnosis of acute pulmonary embolus. Patient presentation with massive unilateral perfusion defect merits further evaluation with pulmonary arteriography.     

Note the descending aorta: predictors of postoperative major adverse aortic event in pure acute type A intramural hematoma

BackgroundIntramural hematomas (IMHs) may originate from small intimal tears. Although most surgeries for acute type A IMH are conventionally performed solely at the proximal aorta, regardless of the primary intimal tear site, the remnant aortic remodeling stays important during the follow-up period after surgery.MethodsForty-seven patients with “pure” acute type A IMHs who underwent surgery from January 2008 to December 2019 were retrospectively analyzed. Acute type A IMH in the entire region without penetrating aortic ulcer (PAU) and aortic dissection (AD), which upon initial computed tomography (CT), can be considered as an intimal tear site, was defined as “pure” type. The maximal diameter of the aorta, maximal thickness of the IMH, and hematoma thickness ratio (HTR) of the ascending and descending aortae were measured from the preoperative computed tomographic scan. The hematoma thickness index was defined as the HTR of the descending aorta divided by that of the ascending aorta. Major adverse aortic events (MAAEs) were defined as AD, rupture, or newly developed PAU and aortic death. Predictors for postoperative MAAEs were analyzed using preoperative computed tomographic findings.ResultsThe measurements of the descending aorta were larger and those of the ascending aorta were smaller in the MAAEs group, than in the corresponding other. The hematoma thickness index was significantly higher in the group with MAAEs, than in the group without; this variable was an independent predictor of MAAEs. During surgery, intimal tears were found in 16/47 (34%) patients. The hematoma thickness index was significantly smaller in the group with intimal tears than in the group without the tears. The aortic measurement appears to reflect the tear site.ConclusionsHematoma thickness index was an independent predictor of MAAE after acute type A IMH surgery. Long-term periodical follow-up with early reintervention may, therefore, be necessary to improve outcome in these patients. As the optimal treatment method is still controversial, inferring the location of the primary tear through the hematoma thickness index can be helpful in determining the treatment method.     

Systematic review and meta-analysis of aortic valve-sparing surgery versus replacement surgery in ascending aortic aneurysms and dissection in patients with Marfan syndrome and other genetic connective tissue disorders

BackgroundAortic aneurysm and dissection are important causes of morbimortality in patients with Marfan syndrome (MFS) and other connective tissue diseases that affect the cardiovascular tissues. Timely intervention through different surgical techniques improves the prognosis. Both sparing and replacement-type interventions of the aortic valve are used, but selection depends on the condition of the patient at the time of diagnosis, the patient’s emergency condition, surgeon preference and hospital resources. Previous meta-analyses have suggested an advantage with the use of sparing-type interventions, but this finding must be updated and extended to patients with other connective tissue disorders. The objetive of this study is to evaluate the outcomes of valve-sparing root replacement versus aortic root replacement procedures in patients with MFS and similar connective tissue diseases that present with aortic aneurysm or dissection.MethodsA systematic review of cohort studies that evaluated sparing-type (preserving, remodeling, reimplantation, Yacoub, David or Florida Sleeve) or replacement-type (repair, Bentall, Button-Bentall, composite valve graft or Cabrol) procedures in patients with Marfan, Loeys-Dietz, Beals-Hecht or Ehlers-Danlos syndromes was done. Studies were retrieved from the SCOPUS, MEDLINE, CINAHL, EMBASE and LILACS electronic databases up to January 2020 without language restrictions. Only studies that directly compared sparing- versus replacement-type procedures were included in the meta-analysis.ResultsA total of 33 studies (n=1,807 subjects) reported sparing-type surgical interventions and 26 studies (n=2,218 subjects) reported replacement-type surgical interventions. Pooled rates of endocarditis, thromboembolism and aneurysm were higher in replacement-type surgical intervention studies. Sixteen studies were included in the meta-analysis. Sparing-type interventions were associated with a reduced risk of endocarditis (RR =0.13, 95% CI: 0.03–0.61); however, replacement-type interventions favored freedom from valve reoperation (RR =2.39, 95% CI: 1.24–4.60). All studies were at low risk of bias.ConclusionsThe choice of the best surgical technique is dependent on the type of disease (MFS or other connective tissue diseases) as well as the accompanying aortic and cardiovascular damage, since these key factors are heterogeneous. Although the results of this meta-analysis tend to show some advantages for one type of surgical intervention over the other and viceversa, the surgeon can only make the best decision during the surgical act.     

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

BackgroundOlder age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair.MethodsRetrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group.ResultsBetween January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87).ConclusionsMorbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts.     

Changes in aortic arch geometry and the risk for Stanford B dissection

BackgroundThe increase in aortic diameter is not closely associated with type B aortic dissection (TBAD); morphological risk factors other than aortic diameter may help to better identify patients at risk for TBAD. The purpose of this study was to investigate possible morphological factors associated with the occurrence of TBAD.MethodsThis study was a retrospective, multicenter, cross-sectional study. We collected 94 patients with TBAD as the TBAD group and 534 patients with healthy aortas as the healthy control group. Morphometric data were collected on three-dimensional models of the thoracic aorta. A propensity score matching (PSM) analysis was conducted to reduce the potential for confounding by baseline factors.ResultsThe number of patients in the TBAD group was 75 after PSM. Longer lengths of the aortic arch (28.00±7.42 vs. 25.14±7.11 cm) were observed in patients with TBAD. The width (80.04±17.27 vs. 71.73±15.55 mm) and height (24.92±11.39 vs. 19.37±10.10 mm) of the aortic arch in patients with TBAD were both larger than those of healthy controls. The morphological changes associated with the occurrence of type B acute dissection were most pronounced in the geometry of the aortic arch.ConclusionsThis study demonstrates that TBAD was associated with longer lengths of aortic arch and with larger arch height and width.     

Increasing atmospheric temperature implicates increasing risk for acute type A dissection in hypertensive patients

BackgroundAcute type A aortic dissection (AAAD) is a life-threatening condition with high mortality within 24 hours. We hypothesized if there is a correlation between seasonal weather changes and the occurrence of AAAD. The aim of the present study was to identify seasonal specific weather and patient characteristics predicting the occurrence of AAAD.MethodsThis is a retrospective analysis of all consecutive patients of our department with AAAD between January 1st 2006 and December 31st 2016. The national meteorological department provided the data of temperature, humidity and air pressure during the study period. The occurrence of AAAD, preoperative neurological impairment and mortality were analyzed in correlation with the obtained daily weather data within the entire cohort and in patients with and without hypertension separately.ResultsA total of 517 patients were included. Mean age was 63.4±13 years, 69.4% were male and 68.8% had documented hypertension. In-hospital mortality was 17.7%. In the whole cohort, the occurrence of AAAD was significantly increased in March, October, December (P=0.016). In hypertensive patients, the occurrence was increased 34% with rising temperature (0.1–9.6 °C, OR1.34, 95% CI: 1.06–1.69, P=0.015). There was no correlation between weather variables and preoperative neurological impairment or mortality.ConclusionsOur data suggests a relation between an increasing number of events of AAAD and certain months within our catchment area and a significantly increased occurrence with rising temperatures (independent from absolute temperature at time of the event) in hypertensive patients.     

Aorta and aortic valve morphologies predisposing to aortic dissection: An in vivo assessment with ransoesophageal echocardiography

Predisposing factors for aortic dissection are well known fromnecropsy series. To evaluate the frequency of aortic and aorticvalve disease in aortic dissection in vivo, 139 patients withacute aortic dissection (96 men, 43 women, mean age 60.5 ±15.7 years) were studied by transoesophageal echocardiography(TEE) using 3.5 and 5.0 MHz transducers. Left ventricular hypertrophyby TEE, defined as an end-diastolic wall thickness of the leftventricular septal wall over 1.5 cm, was found in 42 (67.7%)of 62 patients with type I, in 10 (58.8%) of 17 patients withtype II and in 46 (76.7%) of 60 patients with type III dissection.The mean value for the aortic root diameter was 3.2 ±1.3 cm. m^–2 in type I dissection and 2.8 ± 0.9cm. m^–2 (ns) in type II dissection. In the patient groupwith type III dissection this diameter was significantly smaller(1.8 ± 0.9 cm m^–2; P<0.001). Thickening of aorticvalve leaflets was demonstrated in six (9.7%) of 62 patientswith aortic dissection type I (two of them with mild aorticstenosis), in two (11.8%) of 17 patients with aortic dissectiontype II and in 15 (25.0%) of 60 patients with aortic dissectiontype III. A bicuspid aortic valve was diagnosed in five (6.3%)of 79 patients with aortic dissection types I and II and inone (1.7%) of 60 patients with type III dissection. By colourcoded Doppler echocardiography, aortic regurgitation was foundin 46 (74.2%) of 62 patients with type I, 13 (76.5%) of 17 patientswith type II and 23 (38.3%) of 60 patients with type III dissection.A coarctation of the aorta was present in two patients. TEE allows the diagnosis of aortic dissection, as well as ofaccompanying pathologies of the aorta and aortic valve. Factorspredisposing for aortic dissection can be detected in vivo.     

Application of prosthesis eversion method for ascending aorta replacement guarantees better clinical outcomes of type A acute aortic dissection surgery

BackgroundThe advantages of prosthesis eversion method in patients diagnosed with Stanford type A acute aortic dissection (AAD) undergoing ascending aorta replacement (AAR) is unknown. This research is designed to explore it.MethodsWe retrospectively analyzed the data of a total of 283 patients diagnosed with type A aortic dissection that underwent surgery in Renmin Hospital of Wuhan University from March, 2006 to April, 2020. Eighty-eight patients underwent surgical repair with traditional continuous suture technique, and 195 patients received prosthesis eversion. Baseline data, intra-operative data and early-stage clinical results were collected and statistically analyzed.ResultsBaseline data were similar except for age, incidence of hyperlipidemia and taking ACEI/ARB drugs (P<0.05). Cardiopulmonary bypass time, cross-clamp time, circulation arrest time, hemostasis time and total operation time in the traditional method group were far longer than in the prothesis eversion group (P<0.01). The operative mortality was similar (P>0.01). Post-operatively, there was no statistically significant difference in the mean ventilation time, mortality, incidence of re-exploration, tracheostomy, paraplegia, long-term coma and stroke between the two groups (P>0.05). Patients in the traditional method group had a longer duration stay in ICU and hospital than patients in the prosthesis eversion group (P<0.05). Patients in the traditional method group received more red blood cells (RBC) (P<0.01), plasma (P<0.05), fibrinogen (P<0.01) and albumin (P<0.05) transfusions, and CoSeal™ surgical sealant (P<0.05) than patients in the prosthesis eversion group.ConclusionsOur experience and statistical analysis showed prosthesis eversion method to have some advantage in reducing blood loss and improving clinical results compared with repair with continuous suture. This technique is both simple to learn and perform.     

接受手术的二瓣化和三瓣化主动脉瓣患者的临床差异

目的研究需要接受主动脉瓣膜或者升主动脉手术的二瓣化或者三瓣化主动脉瓣膜患者的临床差异.方法将1996-2001年的2 570例主动脉瓣膜病变患者,根据主动脉瓣膜形态分为二组,2 015例(78.4%)是三瓣化瓣膜,555例(21.6%)是二瓣化主动脉瓣膜,具体研究统计各项相关数据.结果男性患者在二组中均明显多于女性,在二瓣化组中尤其明显.在二组中早期导致手术的瓣膜病变均是瓣膜狭窄.二瓣化瓣膜的患者接受主动脉瓣膜或者升主动脉手术的年龄平均比三瓣化瓣膜的患者年轻10岁.在二瓣化患者中的升主动脉扩张的发生率明显高于三瓣化的患者.但是在A型主动脉夹层动脉瘤的患者中,三瓣化瓣膜明显比二瓣化瓣膜多.三瓣化主动脉瓣膜的患者同时接受冠状动脉搭桥手术的概率明显高于二瓣化的患者.结论经临床资料对比显示,主动脉瓣先天性二瓣化畸形会加速瓣膜自身的纤维化、钙化导致瓣膜狭窄和关闭不全的早期出现,并且增加升主动脉扩张的危险性.