Kazui T, Iwaki K, Kawashima T, Iwata M, Sasaki A, Kimura K, Inoue N, Yamada O, Komatsu S
Department of Surgery (Section 2), Sapporo Medical College & Hospital.
Kyobu Geka. 1992 Dec;45(13):1133-8; discussion 1138-40.
Between April 1988 and February 1992, eight patients with type A aortic dissection associated with annuloaortic ectasia (AAE) underwent the concomitant graft replacement of the total aortic root and the transverse aortic arch at our institution. The acuity of the aortic dissection was acute stage in 3 patients and chronic stage in 5 including 3 cases of re-do operation. All operations were performed with an aid of extracorporeal circulation, blood cardioplegia, selective cerebral perfusion and open distal anastomosis. The operative techniques employed in this series consisted of total aortic root replacement using a composite graft (Bentall, Cabrol or Piehler's technique), and total arch replacement using en bloc arch reconstruction or three vessels graft replacement. One patients underwent re-do operation for coronary anastomotic false aneurysm following Bentall operation and aneurysmal dilatation of the false lumen at the aortic arch, and died of LOS because of the prolonged myocardial ischemia. Other seven patients survived the operation, and lead the normal life at the present time. The present data suggests that type A aortic dissection associated with AAE involving aortic arch could be treated by concomitant graft replacement of the total aortic root and the transverse aortic arch.
1988年4月至1992年2月期间，8例伴有主动脉瓣环扩张（AAE）的A型主动脉夹层患者在我院接受了主动脉根部和主动脉弓横部的同期移植置换术。主动脉夹层的急性期为3例，慢性期为5例，其中包括3例再次手术病例。所有手术均在体外循环、血液停搏、选择性脑灌注和开放远端吻合的辅助下进行。本系列采用的手术技术包括使用复合移植物进行主动脉根部全置换（Bentall、Cabrol或Piehler技术），以及使用整块主动脉弓重建或三支血管移植物置换进行主动脉弓全置换。1例患者在Bentall手术后因冠状动脉吻合口假性动脉瘤和主动脉弓处假腔动脉瘤样扩张接受再次手术，因心肌缺血时间延长死于住院期间。其他7例患者手术存活，目前生活正常。目前的数据表明，伴有累及主动脉弓的AAE的A型主动脉夹层可以通过主动脉根部和主动脉弓横部的同期移植置换术进行治疗。
