Rylski Bartosz, Bavaria Joseph E, Milewski Rita K, Vallabhajosyula Prashanth, Moser William, Kremens Emily, Pochettino Alberto, Szeto Wilson Y, Desai Nimesh D
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Heart Center Freiburg University, Freiburg, Germany.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Thorac Surg. 2014 Aug;98(2):582-8; discussion 588-9. doi: 10.1016/j.athoracsur.2014.04.050. Epub 2014 Jun 10.
Acute type A aortic dissection frequently occurs in patients with normally sized aortic roots. The aim of this investigation was to describe the durability of aortic valve resuspension and root repair with a novel technique of reconstruction in type A dissection.
From 1993 to 2013, among 629 patients operated on for acute type A dissection 489 (62% male, median age 62 years (53; 73) underwent aortic valve resuspension and reinforcement of the sinus of Valsalva with a Teflon felt neomedia. The median follow-up time was 4.1 years (1.3; 6.8) (2075 patient-years).
In-hospital mortality was 11% (56/489). Survival was 69%±2%, 50%±3%, and 36%±5% at 5, 10, and 15 years, respectively. Freedom from moderate or severe aortic regurgitation was not influenced by the aortic regurgitation grade at the initial operation (p=0.131). Freedom from proximal aortic reoperation was 96%±1%, 92%±2%, and 89%±4% at 5, 10, and 15 years, respectively. Seventeen patients (3%) required proximal reoperation: 10 for aortic regurgitation, including 3 with concomitant pseudoaneurysm and 2 with root aneurysm; 6 for pseudoaneurysm; and 1 for graft infection.
Aortic root neomedia reconstruction and valve resuspension can be successfully performed in the majority of patients with type A dissection. The in-hospital mortality is low, and the results are durable.
急性A型主动脉夹层常发生于主动脉根部大小正常的患者。本研究的目的是描述一种用于A型夹层重建的新技术进行主动脉瓣重新悬吊和根部修复的耐久性。
1993年至2013年，在629例接受急性A型夹层手术的患者中，489例（男性62%，中位年龄62岁（53；73））接受了主动脉瓣重新悬吊并用特氟龙毡新中膜加固主动脉瓣窦。中位随访时间为4.1年（1.3；6.8）（2075患者年）。
住院死亡率为11%（56/489）。5年、10年和15年的生存率分别为69%±2%、50%±3%和36%±5%。初始手术时的主动脉反流分级对中度或重度主动脉反流的无事件生存率无影响（p = 0.131）。5年、10年和15年近端主动脉再次手术的无事件生存率分别为96%±1%、92%±2%和89%±4%。17例（3%）患者需要近端再次手术：10例因主动脉反流，其中3例合并假性动脉瘤，2例合并根部动脉瘤；6例因假性动脉瘤；1例因移植物感染。
大多数A型夹层患者可成功进行主动脉根部新中膜重建和瓣膜重新悬吊。住院死亡率低，结果持久。
