Kato Yasuyuki, Sasaki Kenichi, Yamauchi Hidetaka, Kanno Yasuyuki, Jinno Taiyo, Yamada Muneaki, Kiyama Hiroshi, Koyanagi Toshiya
Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Saitama, Japan.
Interact Cardiovasc Thorac Surg. 2020 Jan 1;30(1):85-90. doi: 10.1093/icvts/ivz227.
To investigate the early and mid-term results of aortic root remodelling with external ring annuloplasty in acute type A aortic dissection.
From January 2015 to April 2019, a total of 194 patients underwent emergency or urgent operation for acute type A aortic dissection in our hospital. Of these, outcomes in 18 patients who underwent valve-sparing aortic root remodelling with external ring annuloplasty were retrospectively evaluated.
The mean age of the 18 patients was 49 ± 14 years. Fourteen patients (78%) were men. Five patients had Marfan syndrome and 2 patients had bicuspid aortic valve. Two patients had coronary malperfusion and 1 patient had cerebral malperfusion. All 18 patients underwent aortic root remodelling with external ring annuloplasty. Cusp repair using central cusp plication was required in 9 patients. Concomitant procedures were hemiarch replacement in 8 patients, total arch replacement in 7 patients, partial arch replacement in 1 patient and coronary artery bypass grafting to the right coronary artery in 3 patients. Thirty-day mortality rate was 5.6% (1 of 18). Postoperative echocardiography showed aortic regurgitation of <1+ in all patients. During follow-up (mean 56 ± 41 months), 1 case of recurrent aortic regurgitation required aortic valve replacement.
Aortic root remodelling with external ring annuloplasty may be an appropriate treatment in middle-aged or younger patients presenting with acute type A aortic dissection.
探讨采用外环成形术进行主动脉根部重塑治疗急性A型主动脉夹层的早期和中期结果。
2015年1月至2019年4月，我院共有194例患者因急性A型主动脉夹层接受急诊或紧急手术。其中，对18例行保留瓣膜主动脉根部重塑并采用外环成形术患者的结果进行回顾性评估。
18例患者的平均年龄为49±14岁。14例（78%）为男性。5例患有马凡综合征，2例患有二叶式主动脉瓣。2例有冠状动脉灌注不良，1例有脑灌注不良。18例患者均采用外环成形术进行主动脉根部重塑。9例患者需要采用中央瓣叶折叠术进行瓣叶修复。同期手术包括8例半弓置换、7例全弓置换、1例部分弓置换和3例右冠状动脉冠状动脉旁路移植术。30天死亡率为5.6%（18例中的1例）。术后超声心动图显示所有患者主动脉瓣反流均<1+。在随访期间（平均56±41个月），1例复发性主动脉瓣反流患者需要进行主动脉瓣置换。
对于患有急性A型主动脉夹层的中青年患者，采用外环成形术进行主动脉根部重塑可能是一种合适的治疗方法。
