Tang Yangfeng, Liao Zilin, Han Lin, Tang Hao, Song Zhigang, Xu Zhiyun
Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical College, Shanghai 200433, China.
Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):109-113. doi: 10.1093/icvts/ivw416.
Acute type A aortic dissection frequently induces aortic root disease; however, the optimal surgical strategy for aortic root dissection remains a challenge. The objective of this study was to introduce a novel technique for reconstruction of type A dissection to improve patient prognosis.
We performed a retrospective review of 791 consecutive patients with acute type A aortic dissection between January 2003 and July 2015. Among these patients, 151 were selected (72% men, age 51.7 ± 9.8 years) to have the modified sandwich repair of aortic root dissection.
The in-hospital mortality rate of the 151 patients was 6.6% (10/151). During a mean follow-up period of 52.7 ± 28.6 months, the survival rate was 100, 89.1 and 69.7% at 1, 5 and 10 years, respectively. Echocardiography and computed tomographic angiography were performed every year to monitor the pathological change in the aortic root. Freedom from severe aortic regurgitation at 5 years was 100%. No patients required reintervention due to dissection or pseudoaneurysm of the proximal aortic root.
Aortic valve resuspension and repair of the sinus of Valsalva with the modified sandwich technique using Teflon felt strips for acute type A dissection could be reliable and effective.
急性A型主动脉夹层常引发主动脉根部疾病；然而，主动脉根部夹层的最佳手术策略仍是一项挑战。本研究的目的是介绍一种用于A型夹层重建的新技术，以改善患者预后。
我们对2003年1月至2015年7月期间连续收治的791例急性A型主动脉夹层患者进行了回顾性研究。在这些患者中，151例（男性占72%，年龄51.7±9.8岁）接受了主动脉根部夹层的改良三明治修复术。
151例患者的院内死亡率为6.6%（10/151）。在平均52.7±28.6个月的随访期内，1年、5年和10年的生存率分别为100%、89.1%和69.7%。每年进行超声心动图和计算机断层血管造影检查，以监测主动脉根部的病理变化。5年时无严重主动脉瓣反流的发生率为100%。没有患者因主动脉根部夹层或假性动脉瘤需要再次干预。
对于急性A型夹层，采用特氟龙毡条的改良三明治技术进行主动脉瓣重新悬吊和主动脉瓣窦修复可能是可靠且有效的。
