Gelsomino Sandro, Masullo Gianluca, Morocutti Giorgio, Frassani Romeo, Da Col Paolo, Parise Orlando, Spedicato Leonardo, Livi Ugolino
Department of Cardiovascular Sciences, S. Maria della Misericordia General Hospital, Udine, Italy.
Ital Heart J. 2003 Jul;4(7):454-9.
The aim of this study was to evaluate the early and long-term outcomes in patients undergoing a Bentall procedure or its button modification for chronic aortic aneurysms with aortic valve incompetence.
Between January 1986 and January 2002, 65 patients (84% males, mean age 58.9 +/- 11 years) underwent aortic root replacement with a Bentall or a button-Bentall operation. Annuloaortic ectasia was the most frequent cause of aortic disease in this series (n = 37, 56.9%), followed by atherosclerotic aneurysms (n = 22, 33.9%), and post-stenotic dilation (n = 5, 7.7%). One patient (1.5%) underwent redo aortic root replacement,3 (4.6%) had a Marfan syndrome, and 6 (9.2%) underwent a concomitant replacement of the aortic arch. The duration of follow-up ranged from 2 to 192 months (mean 89.6 +/- 21.8 months).
The 30-day mortality was 0%. Early non-fatal complications comprised: bleeding requiring surgical re-exploration (n = 1, 1.5%), low output syndrome (n = 1, 1.5%), acute renal insufficiency (n = 1, 1.5%), transient ischemic attack (n = 2, 3.1%), stroke (n = 1, 1.5%), and pulmonary insufficiency (n = 1, 1.5%). There was a late death due to a pulmonary neoplasm. The 16-year actuarial survival was 97 +/- 2% (hazard 0.02 +/- 0.02). No patient required reoperation. Furthermore, the long-term clinical follow-up was characterized by the complete absence of endocarditis, anticoagulant-related hemorrhage, valve thrombosis, and prosthetic failure. Finally, the NYHA functional status was significantly improved (1.1 +/- 0.50, p < 0.001 vs preoperatively).
The late results of the Bentall and button-Bentall procedures were excellent. Our findings confirm that these techniques still constitute the gold standard in the surgical treatment of combined valve and ascending aorta pathologies.
本研究旨在评估接受Bentall手术或其改良纽扣式手术治疗合并主动脉瓣关闭不全的慢性主动脉瘤患者的早期和长期疗效。
1986年1月至2002年1月期间，65例患者（男性占84%，平均年龄58.9±11岁）接受了Bentall手术或纽扣式Bentall手术进行主动脉根部置换。主动脉瓣环扩张是本系列中主动脉疾病最常见的原因（共患37例，占56.9%），其次是动脉粥样硬化性动脉瘤（共患22例，占33.9%），以及狭窄后扩张（共患5例，占7.7%）。1例患者（1.5%）接受再次主动脉根部置换，3例（4.6%）患有马方综合征，6例（9.2%）同时接受主动脉弓置换。随访时间为2至192个月（平均89.6±21.8个月）。
30天死亡率为0%。早期非致命并发症包括：需再次手术探查的出血（1例，1.5%）、低心排血量综合征（1例，1.5%）、急性肾功能不全（1例，1.5%）、短暂性脑缺血发作（2例，3.1%）、中风（1例，1.5%）和肺功能不全（1例，1.5%）。有1例因肺部肿瘤晚期死亡。16年精算生存率为97±2%（风险率0.02±0.02）。无患者需要再次手术。此外，长期临床随访显示完全没有心内膜炎、抗凝相关出血、瓣膜血栓形成和人工瓣膜功能障碍。最后，纽约心脏协会（NYHA）心功能分级显著改善（1.1±0.50，与术前相比p<0.001）。
Bentall手术和纽扣式Bentall手术的晚期疗效极佳。我们的研究结果证实，这些技术仍然是联合瓣膜和升主动脉病变外科治疗的金标准。
