Kouchoukos N T, Marshall W G, Wedige-Stecher T A
J Thorac Cardiovasc Surg. 1986 Oct;92(4):691-705.
Between September, 1974, and December, 1985, 127 patients had replacement of the ascending aorta and aortic valve with a composite graft. Annuloaortic ectasia was the most common indication for operation (69 patients), followed by aortic dissection (51 patients). Twenty-four patients (19%) had the Marfan syndrome. Hospital mortality was 4.7%. Emergent operation for acute dissection was the only independent predictor of hospital death (p = 0.03). Reoperation for postoperative hemorrhage was required in 15 patients (11.8%) and for prosthesis-related complications (pseudoaneurysm, prosthetic endocarditis, technical problems, and valve thrombosis) in 16 patients (12.6%). Since we adopted a technique of preclotting the prosthesis with whole blood or albumin plus autoclaving and abandoned the inclusion technique, the reoperation rate has declined substantially. At 5 years, the actuarial freedom from reoperation for any reason on the ascending aorta or aortic valve for the 24 patients in whom this modification was used was 90% and for the remaining 103 patients, 73% (p = 0.17). No reoperations for pseudoaneurysms or technical problems were required in these 24 patients, whereas 10 reoperations for these complications were necessary in the other patients. The mean duration of follow-up was 54 months. The actuarial survival rate at 7 years for the entire group was 65%; for the patients with annuloaortic ectasia, 70%; for those with aortic dissection, 61%; for the patients with the Marfan syndrome, 57%. Actuarial freedom from operation on the remainder of the aorta at 7 years was 89%, but it was 78% for the subgroup with the Marfan syndrome. The satisfactory results with extended follow-up support the continued use of the composite graft technique as the preferred method of treatment for patients with annuloaortic ectasia or recurrent aneurysms of the sinuses of Valsalva and for patients with aortic dissection who require aortic valve replacement.
1974年9月至1985年12月期间，127例患者接受了带瓣主动脉升弓部人工血管置换术。主动脉瓣环扩张是最常见的手术指征（69例），其次是主动脉夹层（51例）。24例患者（19%）患有马方综合征。住院死亡率为4.7%。急性夹层的急诊手术是住院死亡的唯一独立预测因素（p = 0.03）。15例患者（11.8%）因术后出血需要再次手术，16例患者（12.6%）因人工血管相关并发症（假性动脉瘤、人工瓣膜心内膜炎、技术问题和瓣膜血栓形成）需要再次手术。自从我们采用了用全血或白蛋白预凝人工血管并结合高压灭菌的技术，摒弃了套入技术后，再次手术率大幅下降。对于采用这种改良方法的24例患者，5年时升主动脉或主动脉瓣因任何原因再次手术的精算免再手术率为90%，其余103例患者为73%（p = 0.17）。这24例患者无需因假性动脉瘤或技术问题进行再次手术，而其他患者中有10例因这些并发症需要再次手术。平均随访时间为54个月。整个组7年时的精算生存率为65%；主动脉瓣环扩张患者为70%；主动脉夹层患者为61%；马方综合征患者为57%。7年时主动脉其余部分免手术的精算率为89%，但马方综合征亚组为78%。延长随访期的满意结果支持继续将带瓣人工血管技术作为主动脉瓣环扩张或瓦尔萨尔瓦窦复发性动脉瘤患者以及需要主动脉瓣置换的主动脉夹层患者的首选治疗方法。
