Division of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan.
Eur J Cardiothorac Surg. 2012 Apr;41(4):e32-6. doi: 10.1093/ejcts/ezr292. Epub 2012 Jan 26.
We evaluated the durability of aortic valve preservation with root reconstruction for acute type A aortic dissection (AAAD).
From January 2002 to March 2011, 140 patients [70 males, 68 ± 12 (SD) years] underwent emergency operation for AAAD. The aortic valve was preserved and one or more Valsalva sinuses were reconstructed. Techniques used for reconstruction were valve resuspension and additional reinforcement of the aortic root with Teflon felt patches, and gelatin-resorcinol-formaldehyde-glue (GRF-glue) was used for mending the dissection. The mean follow-up period was 44.0 ± 26.2 months. We classified the degree of aortic regurgitation (AR) into four grades (0, 1+, 2+ and 3+) using echocardiography. Based on a retrospective analysis of pre-operative echocardiographic findings, the 127 survivors were divided into two groups: group 1 (G1) included 98 patients with 0 or 1+ AR, and group 2 (G2) 29 patients with 2+ or 3+ AR. In addition, we measured the post-operative native aortic root dimension of AAAD patients with use of echocardiography or CT scan.
The operative mortality rate was 9.3% (13/140). Freedom from aortic root re-operation was 100%. Aortic root pseudoaneurysm formation and severe AR requiring aortic valve replacement did not occur. Pre-operative AR of 0.2 ± 0.4 in G1 did not deteriorate (0.5 ± 0.5 at discharge, 0.4 ± 0.4 at follow-up). Meanwhile, pre-operative AR of 2.4 ± 0.5 in G2 improved to 0.6 ± 0.5 (P < 0.05) at discharge and 1.0 ± 0.6 (P < 0.05) at follow-up. The native aortic root dimension in G2 at follow-up was significantly larger than G1 (36.0 ± 4.7 vs. 33.9 ± 5.0 mm).
Aortic valve preservation and root reconstruction appear to be an appropriate surgical approach to AAAD.
我们评估了急性 A 型主动脉夹层（AAAD）行主动脉根部重建保留主动脉瓣的耐久性。
2002 年 1 月至 2011 年 3 月，140 例患者（男 70 例，68±12 岁）因 AAAD 行急诊手术。保留主动脉瓣并重建一个或多个瓦氏窦。重建技术包括瓣膜悬吊和用特氟隆毡片额外加强主动脉根部，用明胶-间苯二酚-甲醛-胶（GRF 胶）修补夹层。平均随访时间为 44.0±26.2 个月。我们使用超声心动图将主动脉瓣反流程度分为四级（0、1+、2+和 3+）。根据术前超声心动图检查结果的回顾性分析，127 例存活患者分为两组：组 1（G1）98 例，主动脉瓣反流 0 或 1+；组 2（G2）29 例，主动脉瓣反流 2+或 3+。此外，我们使用超声心动图或 CT 扫描测量 AAAD 患者术后主动脉根部的自然尺寸。
手术死亡率为 9.3%（13/140）。主动脉根部再次手术的无失败率为 100%。未发生主动脉根部假性动脉瘤形成和严重主动脉瓣反流需要主动脉瓣置换。G1 术前主动脉瓣反流 0.2±0.4 没有恶化（出院时 0.5±0.5，随访时 0.4±0.4）。同时，G2 术前主动脉瓣反流 2.4±0.5 在出院时改善至 0.6±0.5（P<0.05），随访时改善至 1.0±0.6（P<0.05）。G2 患者在随访时的主动脉根部自然尺寸明显大于 G1（36.0±4.7 与 33.9±5.0mm）。
保留主动脉瓣和根部重建似乎是 AAAD 的一种合适的手术方法。
