Komiya Tatsuhiko, Tamura Nobushige, Sakaguchi Genichi, Kobayashi Taira
Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki City, Okayama, Japan.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):306-9. doi: 10.1510/icvts.2008.190223. Epub 2008 Dec 8.
Emergency surgery for acute type A dissection is extremely difficult when the sinuses of Valsalva are widely dissected. Indications for the various proposed surgical approaches are controversial. Here, we describe modified partial aortic root remodeling to overcome bleeding. We retrospectively reviewed 13 consecutive patients who underwent the following operative procedure. We did not resect the sinus but sutured a U-shaped Dacron patch to the inside of the sinus to reinforce the dissected weakened wall. The indications for reconstruction of the aortic root with this technique are extension of an intimal tear into a sinus, a fully dissected sinus as far as the level of the aortic annulus or mild annuloaortic ectasia. One patient died of multiorgan failure. No patient had more than mild aortic regurgitation. Mean follow-up duration was 22 months and there was no late death. Two patients underwent repeated surgery due to graft infection and redissection. Our modified partial aortic root remodeling technique might be a useful surgical procedure if one or two Valsalva sinuses are affected in type A acute aortic dissection.
当主动脉瓣窦广泛剥离时，急性A型主动脉夹层的急诊手术极其困难。各种提议的手术方法的适应证存在争议。在此，我们描述改良部分主动脉根部重塑术以克服出血问题。我们回顾性分析了连续13例行以下手术操作的患者。我们未切除主动脉瓣窦，而是在窦内缝合一个U形涤纶补片以加固剥离的薄弱壁。采用该技术重建主动脉根部的适应证为内膜撕裂延伸至主动脉瓣窦、直至主动脉瓣环水平的完全剥离的主动脉瓣窦或轻度瓣环主动脉扩张。1例患者死于多器官功能衰竭。无患者出现超过轻度的主动脉瓣反流。平均随访时间为22个月，无晚期死亡病例。2例患者因移植物感染和再次剥离接受了再次手术。如果在A型急性主动脉夹层中一两个主动脉瓣窦受累，我们的改良部分主动脉根部重塑技术可能是一种有用的手术方法。
