Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全的疗效观察

目的总结Bentall手术治疗升主动脉瘤合并主动脉瓣关闭不全的治疗效果。方法回顾分析施行Bentall手术32例，其中合并马凡氏综合征16例，主动脉夹层12例（StanfordA型10例、B型1例，壁间血肿1例）；术前心功能（NYHA）Ⅱ级13例、Ⅲ级12例、Ⅳ级7例。结果32例病人中，死亡3例；术后并发症：低心排出量综合征3例，二次开胸止血1例，室性心律失常1例，双下肢肌力一过性下降1例，感染性心内膜炎1例。术后随访30例，时间3—80个月，除1例于术后第10个月死亡，其余29例均恢复良好，心功能在Ⅰ-Ⅱ级。结论Bentall手术是治疗升主动脉瘤合并主动脉瓣关闭不全的有效办法，改善吻合技术、缩短体外循环及深低温停循环时间、保证移植后冠脉有效灌注是提高手术成功率的关键因素。

Surgical treatment of ascending aortic aneurysm by Bentall's procedure

Objective To review our experience in surgical treatment of ascending aortic aneurysm with aortic valve insufficiency in 32 cases by Bentall＇s procedure. Methods 32 patients underwent replacement of the ascending aorta and aortic valve with composite valve vascular prosthesis and received direct implantation of the aortic graft of the coronary orifices （ Bentall＇s procedure）. The range of age was from 28 to 83 years （47 ± 12） years. Among them, 16 were of Marfan＇s syndrome, 12 aortic dissection （ 10 cases of Stanford type A, 2 cases of Stanford type B） and 14 ascending aortic aneurysm complicating severe aortic valve insufficiency. Before operation, 17 cases were in NYHA function class Ⅱ , 10 in class Ⅲ and 5 in class Ⅳ. Concomitant procedures included Bentall and hemiarch grafting in 3 cases, Bentall and mitral valve replacement in 1 case, Bentall and ligation patent ductus arteriosus in 1 case, Bentall and CABG in 1 case. Results There were 2 cases in - hospital deaths, and 1 case death in the follow - up period. Postoperative complication included low cardiac output syndrome in 1 case, reoperation for bleeding in 1 case, arrhythmia in 1 case, central neural system complication in 1 case, endocarditis 1 case, incision infection in 1 case. Postoperative 30 cases were followed up, ranged 3 - 80 months, all of them recovered smoothly, heart function were in class Ⅰ - Ⅱ. Conclusion Bentall＇s procedure can be effective in the treatment of ascending aortic aneurysm with aortic valve insufficiency. To improve surgical technique, reduce the CPB time, decreases the myocardial injury are the essential factors to the surgical success.