Fabiani J N, Jebara V A, Deloche A, Stephan Y, Carpentier A
Clinique de Chirurgie Cardiovasculaire, Hôpital Broussais, Paris, France.
Circulation. 1989 Sep;80(3 Pt 1):I264-8.
Between 1984 and 1988, 15 patients with type A aortic dissection were treated by direct suturing of the intimal tear and extensive sticking of the dissected aortic layers with surgical (gelatin-resorcin-formaldehyde) glue without prosthetic graft replacement. Aortic incompetence was present in 10 patients, a situation that required valvular replacement in five and valvular repair in five. In 10 patients, the dissection extended to the transverse aortic arch, requiring profound hypothermia and circulatory arrest. All patients survived the operation. Follow-up ranged from 6 to 44 months. All patients were monitored by Doppler echocardiographic studies. In addition, 10 underwent angiography; six, a computed tomographic scan; and five, magnetic resonance imaging. In all patients but two, the ascending aorta and transverse arch had a normal appearance. In three patients, a limited dissection persisted that did not require reoperation. Dissection of the descending aorta was present in 10 patients. One patient required a valvular replacement 18 months after surgery, and one underwent heart transplantation for an associated cardiomyopathy 14 months after surgery. These preliminary results indicate that surgical glue can be used safely and efficiently in type A aortic dissection as an alternative to aortic replacement.
1984年至1988年间，15例A型主动脉夹层患者接受了内膜撕裂直接缝合术，并使用外科用（明胶-间苯二酚-甲醛）胶水对主动脉夹层各层进行广泛粘连，未行人工血管置换。10例患者存在主动脉瓣关闭不全，其中5例行瓣膜置换术，5例行瓣膜修复术。10例患者的夹层延伸至主动脉横弓，需要深度低温和循环停止。所有患者均手术存活。随访时间为6至44个月。所有患者均接受多普勒超声心动图检查。此外，10例患者接受了血管造影；6例接受了计算机断层扫描；5例接受了磁共振成像。除2例患者外，所有患者的升主动脉和主动脉横弓外观均正常。3例患者存在局限性夹层，无需再次手术。10例患者存在降主动脉夹层。1例患者术后18个月需要进行瓣膜置换，1例患者术后14个月因相关心肌病接受了心脏移植。这些初步结果表明，手术胶水可安全有效地用于A型主动脉夹层，作为主动脉置换的替代方法。
