Kumamaru H, Yozu R, Kawada K, Kawada S, Nishikawa K, Kono N, Kiso K
Department of Surgery, Keio University School of Medicine.
Kyobu Geka. 1991 Jul;44(8 Suppl):641-5.
Thirty-four patients of ascending aortic aneurysm associated with aortic regurgitation were treated with simultaneous aortic valve and ascending aorta replacement utilizing composite graft, until December 1990. Twenty-four patients of the group were diagnosed as Marfan's syndrome and 17 had aortic dissection. For the operative procedure, Bentall's technique were employed in 25 patients and other modifications in nine. Operative death was observed in three cases (8.8%) due to low output syndrome, caused by coronary ostium abnormality, all in Marfan's syndrome. Late death was observed in six including 2 hospital deaths of cerebro-vascular disturbance and sepsis. Other causes of death were rupture of residual aneurysm (in 3) and LOS at reoperation (in 1). Hospital survivors remarkably improved in NYHA class and in cardiac size. Actuarial survival in 3, 5, 7, and 10 years were 78%, 72%, 72%, and 62% respectively. Therefore, surgical result of composite graft technique in our institution proved to be reasonable as others. However, long term result of the procedure should be carefully evaluated, because of the anatomical and histopathological peculiarity of the disease.
截至1990年12月，34例升主动脉瘤合并主动脉瓣关闭不全的患者接受了同期主动脉瓣和升主动脉置换术，采用复合移植物进行治疗。该组中有24例患者被诊断为马凡综合征，17例有主动脉夹层。手术方式上，25例采用Bentall技术，9例采用其他改良术式。3例（8.8%）患者因冠状动脉开口异常导致低心排综合征死亡，均为马凡综合征患者。晚期死亡6例，其中2例死于医院内脑血管疾病和脓毒症。其他死亡原因包括残余动脉瘤破裂（3例）和再次手术时低心排（1例）。医院存活患者的纽约心脏协会（NYHA）心功能分级和心脏大小显著改善。3年、5年、7年和10年的精算生存率分别为78%、72%、72%和62%。因此，我院复合移植物技术的手术结果与其他机构的结果一样合理。然而，由于该疾病在解剖学和组织病理学上的特殊性，该手术的长期结果仍需仔细评估。
