Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt.
Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Heart Surg Forum. 2021 Sep 28;24(5):E828-E832. doi: 10.1532/hsf.4117.
Type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Many techniques have evolved to repair the dissected sinus segments and restore aortic valve dynamics. Herein, we evaluate the early outcome of a novel technique for reconstruction of dissected aortic root.
A prospective study was conducted on 300 patients to evaluate the early results of repair of dissected root in type A aortic dissection. The mean age was 59.65±8.52 years, and 76% of patients were males. All patients had four standard steps for aortic reconstruction: 1) commissural resuspension; 2) right coronary sinus reinforcement with pericardial and Dacron bands; 3) non-coronary sinus reinforcement using external Dacron patch; 4) circumferential inversion of adventitial layer of the root. Patients were followed up clinically, echocardiographically, and by CT scan.
The in-hospital mortality was 8%. The mean cross-clamp time was 120±30 minutes, and circulatory arrest time was 25+10 minutes. Twenty-seven patients (9%) experienced postoperative complications, including bleeding and acute kidney injury. During a mean follow-up time of 48±12 months, there were no recurrent aortic dissection, aortic dilatation, pseudoaneurysm, or progression of aortic regurgitation during the entire study period.
This reconstructive technique technically is undemanding, feasible, safe, and durable with good early results. A larger cohort of patients with longer period of follow up should generate a more powerful evaluation of this technique.
A型主动脉夹层是一种具有高发病率和死亡率的极具挑战性的外科急症。许多技术已经发展起来，用于修复夹层窦段并恢复主动脉瓣动力学。在此，我们评估一种重建夹层主动脉根部的新方法的早期结果。
对 300 例患者进行前瞻性研究，以评估 A 型主动脉夹层中修复夹层根部的早期结果。平均年龄为 59.65±8.52 岁，76%的患者为男性。所有患者均进行了主动脉重建的四个标准步骤：1）连合复位；2）用心包和涤纶带加固右冠状动脉窦；3）用外部涤纶补丁加固无冠窦；4）根部外膜层的环形反转。患者接受临床、超声心动图和 CT 扫描随访。
院内死亡率为 8%。平均体外循环时间为 120±30 分钟，停循环时间为 25+10 分钟。27 例（9%）患者发生术后并发症，包括出血和急性肾损伤。在平均 48±12 个月的随访期间，整个研究期间均未出现复发性主动脉夹层、主动脉扩张、假性动脉瘤或主动脉瓣反流进展。
这种重建技术技术上要求不高，可行、安全、持久，早期效果良好。更大的患者队列和更长的随访时间应该可以对这项技术进行更有力的评估。
