Fujimatsu Toshihiro, Osawa Hajime, Osaka Shinichi, Takai Fumie, Hashimoto Masaki, Suzuki Hiroyuki
Department of Cardiovascular Surgery, Heart Center, Aizawa Hospital, Matsumoto, Japan.
Ann Thorac Cardiovasc Surg. 2009 Dec;15(6):382-8.
The aim of this study was to assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA) with involvement of the aortic root.
From November 2002 to December 2007, 51 consecutive patients underwent emergency surgical intervention for AADA with involvement of the aortic root. Supracommissural replacement (SCR) of the ascending aorta was applied to 33 of these patients; 12 cases received a Bentall procedure, and 6 underwent partial remodeling technique in which as much as the dissected aortic root was resected, leaving a rim of 10 mm above the noncoronary annulus and 5 mm above the coronary ostia and commissures. Woven Dacron graft tailored in a scallop-shaped configuration to match the noncoronary sinus was then anastomosed to the proximal aortic stump.
Overall hospital mortality was 16% and showed no significant differences among groups. SCR showed a trend toward higher aortic root morbidity. Mean operation time, cardiopulmonary bypass time, and cardiac ischemia time were significantly longer for the Bentall procedure.
In AADA involving aortic root, a partial remodeling technique may be considered the surgical treatment of choice at our institution in suitable patients.
本研究旨在评估3种不同手术方法治疗累及主动脉根部的急性A型主动脉夹层（AADA）的疗效。
2002年11月至2007年12月，51例连续患者因累及主动脉根部的AADA接受了急诊手术干预。其中33例患者采用升主动脉瓣上置换术（SCR）；12例接受Bentall手术，6例采用部分重塑技术，即尽可能切除剥离的主动脉根部，在无冠瓣环上方保留10 mm边缘，在冠状动脉开口和瓣叶上方保留5 mm边缘。然后将剪裁成扇贝形以匹配无冠窦的编织涤纶移植物与主动脉近端残端吻合。
总体医院死亡率为16%，各组之间无显著差异。SCR显示主动脉根部并发症发生率有升高趋势。Bentall手术的平均手术时间、体外循环时间和心肌缺血时间明显更长。
在累及主动脉根部的AADA中，对于合适的患者，部分重塑技术可能是我院的首选手术治疗方法。
