Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Ann Thorac Surg. 2012 Oct;94(4):1230-4. doi: 10.1016/j.athoracsur.2012.04.094. Epub 2012 Jun 28.
The optimal management of the dissected aortic root remains unclear. The purpose of this study was to determine whether aortic valve-sparing root replacement (VSRR) compromises survival in aortic dissection repair and to evaluate the comparative efficacy of 2 types of VSRR procedures.
The Heart Center database (Leipzig, Germany) was reviewed to identify patients who underwent a VSRR for acute type A aortic dissection (AAAD) repair. Patients were classified into 3 groups: Bentall (biological or mechanical valved conduit), Yacoub VSRR, and David VSRR. Intergroup comparisons were performed using the t test and analysis of variance as appropriate.
From March 1995 to April 2010, 208/374 patients (56%) undergoing AAAD repair received an aortic root procedure. Group 1 (n=130) underwent a Bentall operation, group 2 (n=51) underwent a modified Yacoub procedure, and group 3 (n=27) underwent a modified David procedure. Age and logistic European system for cardiac operative risk evaluation (EuroSCORE) as well as cross-clamp, cardiopulmonary bypass, and circulatory arrest times were similar among the groups. Hospital mortality among all 3 groups was similar (group 1, 27%; group 2, 16%; group 3, 15%). At a mean follow-up of 44 months for group 2 and 27 months for group 3, there was no difference in the need for aortic valve replacement for moderate to severe aortic insufficiency (AI) (2/37 survivors in group 2 versus 1/23 survivors in group 3; z score=-0.279; p>0.05). Five-year survival estimates were 66% for group 1, 65% for group 2, and 80% for group 3 (log rank p=0.2).
Both the David and Yacoub techniques have similar midterm durability in AAAD repair. When compared with the Bentall procedure, neither technique compromises short-term or midterm survival after AAAD repair.
对于主动脉根部夹层的最佳处理方法仍存在争议。本研究旨在确定保留主动脉瓣的根部替换术（VSRR）是否会影响主动脉夹层修复术的存活率，并评估两种 VSRR 手术的比较疗效。
回顾莱比锡心脏中心数据库（德国），以确定接受 VSRR 治疗急性 A 型主动脉夹层（AAAD）的患者。患者被分为 3 组：Bentall（生物或机械瓣状导管）、Yacoub VSRR 和 David VSRR。使用 t 检验和方差分析进行组间比较。
1995 年 3 月至 2010 年 4 月，374 例接受 AAAD 修复的患者中有 208 例（56%）接受了主动脉根部手术。第 1 组（n=130）行 Bentall 手术，第 2 组（n=51）行改良 Yacoub 手术，第 3 组（n=27）行改良 David 手术。3 组患者的年龄、欧洲心脏手术风险评估系统（EuroSCORE）评分以及主动脉阻断、体外循环和循环阻断时间均相似。3 组患者的院内死亡率相似（第 1 组 27%，第 2 组 16%，第 3 组 15%）。第 2 组和第 3 组的平均随访时间分别为 44 个月和 27 个月，中度至重度主动脉瓣关闭不全（AI）需要主动脉瓣置换的比例无差异（第 2 组 37 例幸存者中有 2 例，第 3 组 23 例幸存者中有 1 例；z 值=-0.279；p>0.05）。第 1 组、第 2 组和第 3 组的 5 年生存率分别为 66%、65%和 80%（对数秩检验，p=0.2）。
David 和 Yacoub 技术在 AAAD 修复中具有相似的中期耐久性。与 Bentall 手术相比，这两种技术都不会影响 AAAD 修复后的短期或中期存活率。
