复合带瓣人工血管替换升主动脉和主动脉瓣(24例报告)

报告２４例升主动脉瘤伴主动脉瓣关闭不全行升主动脉和主动脉瓣替换及冠状动脉开口移植术（Ｂｅｎｔａｌ术２２例，底盘法２例）。１３例伴有升主动脉夹层分离，对其中８例ＤｅＢａｋｅｙＩ型者，以Ｔｅｆｌｏｎ毡条内外加固主动脉切端后吻合。１３例用人工血管周围间隙与右心耳吻合以控制升主动脉吻合之外的出血。３例以人工血管片环包主动脉吻合口控制局部广泛渗血及出血。２例术毕不能脱离体外循环死亡，手术死亡率８３％。随访平均２１８个月，２例死于蛛网膜下腔出血，１例右股动脉栓塞经手术治愈；其余病人康复良好，心功能（ＮＹＨＡ）Ｉ～ＩＩ级。

Composite Valved Vascular Prosthesis Replacement of the Ascending Aorta and Aortic Valve in 24 Cases

This article is to summarize the experience of surgical treatment of ascending aortic aneurysm(AAA)with aortic insufficiency (AI).May 1990 through March 1995,24 patients with AAA and arotic insufficiency underwent replacement of ascending aorta and aortic valve with composite valved vascular prosthesis and direct implantation of the coronary orifices to the aortic graft(Bentall technique in 22 cases and button method in 2)with satisfactory early and late results.Thirteen patients had ascending aortic dissection.Teflon felt strips were placed both inside and outside the ascending aortic cuff to reinforce the aortic wall at the site of anastomosis in 8 cases of type I dissection.Graft preclotting introduced by Cooley was used to control oozing.In 13 cases,a fistula was created between the closed perigraft space and right auricular appendage to drain the accumulated blood.The sites of aortic anastomoses were wrapped with strips of prosthesis to stop oozing or bleeding in 3 cases.Two poor risk patients could not be weaned from CPB.The overall operative mortality was 8.3%.Two patients succumbed to subarachnoid hemorrhage during follow up(mean 21.8 months).One case suffered from thromboembolism of right femoral artery and was cured by embolectomy.The rest had a good convalescence(NYHA class I-II).