Osinowo O, Ross J K, Monro J L
Thorac Cardiovasc Surg. 1985 Feb;33(1):23-5. doi: 10.1055/s-2007-1014075.
Aortic root enlargement with a patch is sometimes indicated either to prevent aortic homograft valve distortion during implantation or to facilitate easy, tension-free closure of the aortotomy. Patches made of prosthetic material have been widely used for this purpose. The use of autogenous pericardium has recently been reported. Although dura mater has been shown to have great strength, low antigenicity, athrombogenicity, easy availability in large sizes and rapid bonding to most tissues, its use for patch enlargement of the aortic root has not been previously documented. From 1979 to 1983, 38 patients had dura mater aortic root gussets placed during aortic valve replacement at the Southampton General Hospital. In all cases, the patches were placed to facilitate aortic closure, or to prevent homograft valve distortion by enlarging the non-coronary sinus. Aortic homografts were implanted in 11 patients, Carpentier Edwards' Xenograft valves in 16, Björk-Shiley valves in 8 and Wessex Xenografts in 3 patients. All the patients survived and in a mean follow-up of 30 +/- 12.8 months (range 3 to 48 months) there has been no clinical evidence of patch failure due to leakage, rupture or aneurysm formation. These results suggest that glycerol-preserved dura mater is a satisfactory patch material for aortic root enlargement during aortic valve replacement.
有时需要用补片扩大主动脉根部，以防止主动脉同种异体瓣膜在植入过程中变形，或便于主动脉切口轻松、无张力地闭合。人工合成材料制成的补片已广泛用于此目的。最近有报道使用自体心包。尽管硬脑膜已被证明具有高强度、低抗原性、抗血栓形成性、易于获得大尺寸材料以及能快速与大多数组织结合等优点，但其用于主动脉根部补片扩大术此前尚无文献记载。1979年至1983年期间，在南安普敦总医院有38例患者在主动脉瓣置换术中使用了硬脑膜主动脉根部补片。所有病例中，放置补片都是为了便于主动脉闭合，或通过扩大无冠状窦来防止同种异体瓣膜变形。11例患者植入了主动脉同种异体瓣膜，16例植入了卡朋蒂埃·爱德华兹生物瓣，8例植入了比约克-希利瓣膜，3例植入了韦塞克斯生物瓣。所有患者均存活，平均随访30±12.8个月（范围3至48个月），尚无因渗漏、破裂或动脉瘤形成导致补片失效的临床证据。这些结果表明，甘油保存的硬脑膜是主动脉瓣置换术中用于扩大主动脉根部的一种令人满意的补片材料。
