心脏术后再次行主动脉根部置换的临床分析

目的探讨心脏术后再次行主动脉根部置换手术的病因、手术操作及临床疗效。方法回顾性分析2013年12月至2019年12月30例心脏手术后于我院行再次主动脉根部置换手术患者的临床资料,其中男20例、女10例,年龄(50.4±12.7)岁。再次手术时间间隔(8.0±8.5)年,再次手术原因包括:主动脉窦部扩张及升主动脉瘤14例(47%),再发主动脉夹层5例(17%),假性动脉瘤3例(10%),人工瓣膜心内膜炎4例(13%),瓣周漏4例(13%),再次手术均为正中开胸,行Bentall手术。同期行二尖瓣置换手术2例,二尖瓣成形手术3例,三尖瓣成形手术6例,冠状动脉旁路移植手术3例,2例DebakeyⅠ型的主动脉夹层患者同期行主动脉全弓置换+降主动脉象鼻支架植入手术。结果术中体外循环时间96~296(161.3±43.0)min,主动脉阻断时间48~117(85.7±20.4)min。术后住院期间死亡5例(17%),主要死因包括心力衰竭及感染性休克。术后随访3~75(33.5±21.1)个月,随访期间死亡3例,其中1例死于感染性休克,2例死于脑出血。结论心脏术后再发主动脉根部病变处理较为棘手,手术风险较高。术前需进行充分评估,合适的手术入路、充分的心肌保护、完善的手术方案对保证手术成功至关重要。

Clinical analysis of redo aortic root replacement after cardiac surgery

Objective To analyze the etiologies,operation techniques and outcomes of redo aortic root replacement after cardiac surgery.Methods Between December 2013 and December 2019,30 patients who had at least one previous cardiac operation received aortic root replacement in our hospital,including 20 males and 10 females with an average age of 50.4±12.7 years.The mean time interval between this operation and the previous one was 8.0±8.5 years.The principal indication for surgery was aortic sinus dilatation and ascending aortic aneurysm in 14 patients(47%),acute aortic dissection in 5 patients(17%),pseudoaneurysm in 3 patients(10%),prosthetic valve endocarditis in 4 patients(13%),prosthetic leakage in 4 patients(13%).Bentall procedure was used in all 30 patients,with concomitant mitral valve plasticity or replacement in 5 patients,tricuspid valve plasticity in 6 patients,coronary artery bypass grafting in 3 patients,and total aortic arch replacement and elephant trunk procedure in 2 patients.Results The mean cardiopulmonary bypass time was 96-296(161.3±43.0)min,and the mean aortic occlusion time was 48-117(85.7±20.4)min.There were 5 in-hospital deaths with an overall in-hospital mortality of 17%.The causes of deaths were low cardiac output syndrome in2 patients and septic shock in 3 patients.The follow-up time was 3-75(33.5±21.1)months.Three patients died during the follow-up,1 patient died of septic shock and 2 died of cerebral hemorrhage.Conclusion Redo aortic root replacement is difficult to deal with,and the risk is high.Preoperative evaluation is required,appropriate surgical approach,adequate myocardial protection,and a complete surgical plan are essential to ensure the success of the operation.