Carrel T, von Segesser L, Jenni R, Gallino A, Egloff L, Bauer E, Laske A, Turina M
Clinic for Cardiovascular Surgery, Zurich, Switzerland.
Eur J Cardiothorac Surg. 1991;5(3):137-43. doi: 10.1016/1010-7940(91)90212-3.
Five to fifteen percent of patients undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. On the other hand, a dilated ascending aorta is known to be a potential source of complications after AVR. From 1972 to 1988, 2278 AVR, either isolated or combined with a second cardiac procedure, were performed in our institution. In the same time interval, a dilated ascending aorta was treated in additional 291 consecutive patients during AVR. Three different surgical options were employed: aortic remodelling and external wall support in 164 patients (56.4%), composite graft replacement in 81 patients (27.8%) and a supracoronary graft in 46 patients (15.8%). Early mortality was 4.8%. Aortic remodelling plus external wall support had the lowest early mortality (1.8%) and the best 8-year survival (89.6%). Supracoronary grafting had a higher early mortality (6.4%) and lower 8-year survival (73.2%). The results of the composite graft were least favourable: early mortality was 9.8% and 8-year survival 76.5%. The results point out the necessity for instituting the appropriate surgical procedure for a dilated ascending aorta during AVR. They show that conservative aortic surgery with preservation of endothelial lining gives excellent early and late results.
接受主动脉瓣置换术（AVR）的患者中有5%至15%会出现升主动脉瘤，需要同时进行外科手术。另一方面，已知扩张的升主动脉是AVR术后并发症的潜在来源。1972年至1988年期间，我们机构共进行了2278例AVR手术，其中包括单纯手术或与第二次心脏手术联合进行的手术。在同一时间间隔内，另外291例连续患者在AVR期间接受了扩张升主动脉的治疗。采用了三种不同的手术方案：164例患者（56.4%）采用主动脉重塑和外壁支撑；81例患者（27.8%）采用复合移植物置换；46例患者（15.8%）采用冠状动脉上移植物。早期死亡率为4.8%。主动脉重塑加外壁支撑的早期死亡率最低（1.8%），8年生存率最佳（89.6%）。冠状动脉上移植物的早期死亡率较高（6.4%），8年生存率较低（73.2%）。复合移植物的结果最不理想：早期死亡率为9.8%，8年生存率为76.5%。这些结果指出了在AVR期间针对扩张的升主动脉采取适当手术方案的必要性。结果表明，保留内皮内衬的保守主动脉手术能取得优异的早期和晚期效果。
