Montalvo Jose, Razzouk Anees, Wang Nan, Bansal Ramesh, Rasi Alfredo, Hasaniya Nahidh, Floridia Rosario, Bailey Leonard
Loma Linda University Medical Center, Loma Linda, California, USA.
Am Surg. 2011 Jan;77(1):88-92.
Controversy exists regarding aortic root reconstruction in the management of acute type A aortic dissection (AAD). One hundred fifty-four patients (mean age 56.9 ± 11.3 years) with AAD had surgical repair between 1996 and 2007. Group 1 (n = 110) required no aortic root surgery. Seventy-one patients had ascending aortic replacement. The aortic valve was repaired in 37 patients (34%) and replaced in one. Group 2 (n = 44) had aortic root surgery. Thirty-four patients had composite root replacement, and seven had a valve-sparing root replacement. Root reconstruction and separate valve replacement was accomplished in three. Hemiarch replacement was included in 39 (35.4%) Group 1 patients and in 12 (27.9%) Group 2 patients. Forty-nine of the 154 patients presented in cardiogenic shock. Multiple risk factors for operative mortality were analyzed. The overall operative mortality was 9.7 per cent: 11 per cent for Group 1 and 6.8 per cent for Group 2 (P = NS). By multivariate analysis, preoperative shock (P = 0.03, odds ratio [OR] = 5.48), postoperative ventricular arrhythmias (P = 0.002, OR = 4.62), and packed red blood cell transfusion (P = 0.002, OR = 1.15) were independent predictors of hospital death. Prompt surgical treatment of AAD before cardiogenic shock ensues can improve the outcome of patients. When indicated, aortic root surgery can be performed without increased mortality and morbidity.
关于急性A型主动脉夹层（AAD）治疗中主动脉根部重建存在争议。1996年至2007年间，154例（平均年龄56.9±11.3岁）AAD患者接受了手术修复。第1组（n = 110）无需进行主动脉根部手术。71例患者进行了升主动脉置换。37例（34%）患者的主动脉瓣进行了修复，1例进行了置换。第2组（n = 44）进行了主动脉根部手术。34例患者进行了复合根部置换，7例进行了保留瓣膜的根部置换。3例患者完成了根部重建和单独的瓣膜置换。第1组39例（35.4%）患者和第2组12例（27.9%）患者进行了半弓置换。154例患者中有49例出现心源性休克。分析了手术死亡率的多个危险因素。总体手术死亡率为9.7%：第1组为11%，第2组为6.8%（P = 无显著性差异）。多因素分析显示，术前休克（P = 0.03，比值比[OR] = 5.48）、术后室性心律失常（P = 0.002，OR = 4.62）和浓缩红细胞输注（P = 0.002，OR = 1.15）是医院死亡的独立预测因素。在发生心源性休克之前对AAD进行及时的手术治疗可以改善患者的预后。如有指征，进行主动脉根部手术不会增加死亡率和发病率。
