正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形

目的总结正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形的外科治疗经验，以提高手术疗效。方法1997年7月至2008年7月，采用正中切口解剖外旁路移植术一期治疗主动脉缩窄合并心脏畸形31例，其中男20例，女11例；年龄31．9±11．7岁。合并的心脏畸形包括：主动脉瓣狭窄或关闭不全22例，二尖瓣狭窄或关闭不全9例，动脉导管未闭5例，升主动脉瘤4例，室间隔缺损3例，冠心病2例。解剖外旁路移植术包括升主动脉-腹主动脉旁路移植术22例，升主动脉-心包后降主动脉旁路移植术9例。同期手术包括主动脉瓣置换术16例，主动脉根部置换术6例，二尖瓣成形或置换术9例，升主动脉置换或成形术4例，动脉导管未闭缝合术5例，室间隔缺损修补术3例，冠状动脉旁路移植术2例。结果住院死亡1例（3．2％），术后39d死于感染性中毒性休克。术后上、下肢收缩压压差较术前明显下降（13．7±10．2mmHg vs．64．2±25．3mmHg，P〈0．05）。随访27例，随访时间4～73个月，无晚期死亡、与人工血管相关的并发症和再次手术患者。结论正中切口解剖外旁路移植术是一期治疗成人及青少年主动脉缩窄合并心脏畸形的一种安全有效的手术方法。升主动脉腹主动脉旁路移植术及升主动脉-心包后降主动脉旁路移植术均可获得满意疗效。

Extra-anatomic Aortic Bypass Grafting Through Median Sternotomy for One-stage Treatment of Aortic Coarctation and Associated Cardiac Diseases

Objective To summarize the experience of extra-anatomic aortic bypass grafting through median sternotomy for one-stage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients（20 male, 11 female; age 31.9±11.7 years） with aortic coarctation and associated cardiac anomalies underwent one-stage surgical repair through median sternotomy. The associated cardiac anomalies included： aortic valve insufficiency or stenosis（n = 22）; mitral valve insufficiency or stenosis （n=9） ; patent ductus arteriosus （n=5） ; ascending aortic aneurysm （n=4） ; ventricular septal defect （n = 3）; coronary artery disease （n = 2）. Extra anatomic aortic bypass grafting was used to repair the coarctation, kouting of the grafts was： ascending-to- posterior pericardial descending aorta （n = 9） and ascending-to- infrarenal abdominal aorta （n=22）. Concomitant cardiac procedures included： aortic valve replacement in 16; Bentall procedures in 6 ; mitral valve repair or replacement in 9 ; ascending aortic replacement or aortoplasty in 4 ; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an in-hospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2 ± 25.3 mm Hg preoperatively to 13.7 ± 10.2 mm Hg postoperatively （P〈0. 05）. Twenty-seven patients were followed up from 4 to 73 months, there were no late deaths, reoperations or graft-related complications. Conclusion Extra-anatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for one-stage surgical repair in adults and adolescents. Both ascending-to- posterior pericardial descending aort