Byrne J G, Mihaljevic T, Lipson W E, Smith B, Fox J A, Aranki S F
Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
Eur J Cardiothorac Surg. 2001 Aug;20(2):252-6. doi: 10.1016/s1010-7940(01)00799-0.
The composite mechanical valve conduit has been most commonly used for patients who require combined aortic valve, root, and ascending aorta replacement, but is limited, especially in the elderly, because of the need for long-term anticoagulation. We report the first consecutive series of patients in whom a composite stentless valve with graft extension, which does not require long-term anticoagulation, was performed.
Between April 1998 and July 2000, eight patients with severe aortic root and ascending aortic pathology underwent a combined aortic valve, root, and ascending aorta replacement with a Freestyle stentless porcine valve with a Hemashield graft extension. Mean age was 74 (range 56--82), three were males. Concomitant procedures included coronary artery bypass graft (CABG) alone (n=2), mitral valve replacement with atrial septal defect repair (n=1) and CABG with septal myomectomy (n=1).
Operative mortality was zero. Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 min, respectively. Two patients returned to the operating room for bleeding. Median blood transfusions and hospital length of stay were 4 units and 11 days, respectively.
The composite stentless valve with graft extension is a reasonable alternative to a mechanical valve conduit for patients who require a combined aortic valve, root, and ascending aorta replacement, in whom anticoagulation is not desirable or contraindicated.
复合机械瓣膜管道最常用于需要同时进行主动脉瓣、主动脉根部和升主动脉置换的患者，但由于需要长期抗凝，其应用受到限制，尤其是在老年患者中。我们报告了首例连续系列患者，他们接受了无需长期抗凝的带移植物延长的复合无支架瓣膜置换术。
1998年4月至2000年7月期间，8例患有严重主动脉根部和升主动脉病变的患者接受了主动脉瓣、主动脉根部和升主动脉联合置换术，使用的是带有Hemashield移植物延长的Freestyle无支架猪瓣膜。平均年龄为74岁（范围56 - 82岁），男性3例。同期手术包括单纯冠状动脉旁路移植术（CABG）（n = 2）、二尖瓣置换术合并房间隔缺损修补术（n = 1）以及CABG合并室间隔肌瘤切除术（n = 1）。
手术死亡率为零。主动脉阻断和体外循环时间的中位数分别为150分钟和203分钟。2例患者因出血返回手术室。输血中位数和住院时间分别为4单位和11天。
对于需要同时进行主动脉瓣、主动脉根部和升主动脉置换且不适合或禁忌抗凝的患者，带移植物延长的复合无支架瓣膜是机械瓣膜管道的合理替代方案。
