Orozco-Sevilla Vicente, Whitlock Richard, Preventza Ourania, de la Cruz Kim I, Coselli Joseph S
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
Int J Angiol. 2018 Jun;27(2):92-97. doi: 10.1055/s-0038-1649485. Epub 2018 May 17.
Aortic root aneurysm is the most common cardiovascular manifestation requiring surgical intervention in patients with Marfan syndrome (MFS), a heritable thoracic aortic disease. Elective replacement of the aortic root is the treatment of choice for patients with aneurysmal complications of the aortic root and ascending aorta. There are two basic approaches to aortic root replacement: valve-sparing (VS) and valve-replacing (VR) techniques. After successful aortic root replacement surgery, several patients with MFS may develop a late complication related to their aortic disease process, such as developing a pseudoaneurysm of the coronary artery reattachment buttons, aneurysmal expansion, or aortic dissection in the remaining native aorta. These patients may also develop other late complications that are not specifically related to the heritable thoracic aortic disease, such as infections that can lead to dehiscence of some or all of the distal or proximal anastomosis. Because these complications are rare, the clinical volume of reoperations of the aortic root in patients with MFS is low, making it difficult to assess contemporary experiences with these procedures. Only a few published reports have examined reoperative aortic root surgery in patients with MFS, each of which had only a small series of patients. Herein, we describe our contemporary experience with reoperative aortic root replacement in patients with MFS and provide our operative approach for these uncommon procedures.
主动脉根部瘤是马凡综合征（MFS）患者最常见的需要手术干预的心血管表现，马凡综合征是一种遗传性胸主动脉疾病。对于主动脉根部和升主动脉出现动脉瘤并发症的患者，选择性主动脉根部置换是首选治疗方法。主动脉根部置换有两种基本方法：保留瓣膜（VS）和置换瓣膜（VR）技术。在成功进行主动脉根部置换手术后，一些马凡综合征患者可能会出现与主动脉疾病进程相关的晚期并发症，例如冠状动脉重新附着纽扣处形成假性动脉瘤、动脉瘤扩张或剩余主动脉发生主动脉夹层。这些患者还可能出现其他与遗传性胸主动脉疾病无特定关联的晚期并发症，如感染，可导致部分或全部远端或近端吻合口裂开。由于这些并发症罕见，马凡综合征患者主动脉根部再次手术的临床病例数较少，因此难以评估这些手术的当代经验。仅有少数已发表的报告研究了马凡综合征患者的再次手术主动脉根部手术，每份报告的患者系列都很小。在此，我们描述我们在马凡综合征患者再次手术主动脉根部置换方面的当代经验，并提供我们针对这些不常见手术的手术方法。
