主动脉根部替换术231例临床分析

目的 探讨主动脉根部替换术的手术适应证。总结手术技术和经验。方法 自１９９４年１月至１９９９年８月,我院共完成２３１例主动脉根部替换术,其中急诊手术１３例。男１８９例,女４２例。年龄１４～６９岁,瘤体直径５～１１ｃｍ。单纯主动脉根部瘤１４５例,ＤｅＢｃｋｅｙⅠ型主动脉夹层６５例,ＤｅＢｅｋｅｙⅡ型主动脉夹层２１例,手术以复合带瓣人工血管组件替换主动脉根部２２９例,行保留主动脉瓣的主动脉根部替换术２

Aortic root replacement of 231 cases

OBJECTIVE: To discuss the operative indications, methods, and surgical techniques of aortic root replacement for aortic not aneurysm. METHODS: Between January 1994 and August 1999, 231 consecutive patients underwent aortic root replacement in our institution, and 13/231 were treated on an emergency basis. They were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11.0 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type I aortic dissection, and the remaining 21 were diagnosed as DeBakey type II aortic dissection. Aortic valve regurgitation was involved in all patients. Aortic root replacement was performed with composite valved graft in 229 patients, and 2 patients reserved the aortic valve. RESULTS: Hospital mortality was 3.03% (7 patients). The early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, and cerebral infarction, pleural effusion and pneumothorax each in 2 patients. One hundred and seventy-five patients (78.12%) were followed up, with a mean follow-up period of 15.7 +/- 13.1 months (range, 2 weeks to 65 months). One patient died from lower-limb embolism and renal dysfunction at 3 months postoperatively. Three patients died from postoperative anticoagulant accidents. The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68.1 mm +/- 9.4 mm, range: 54 to 112; vs 54.8 mm +/- 8.2 mm, range: 38 to 88; P < 0.001). CONCLUSIONS: Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm. Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general condition permit.