Huang Ling-Chen, Liu Chuang, Fan Shu-Ya, Sun Yang-Xue, Guo Hong-Wei
Department of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.
J Thorac Dis. 2023 Aug 31;15(8):4337-4345. doi: 10.21037/jtd-23-201. Epub 2023 Aug 3.
This study was designed to evaluate the clinical outcomes of our modified cuff wrapping Bentall (M-Bentall) procedure, which uses a cuff wrapping technique with remnant aortic root tissue.
From July 2017 to December 2021, a total of 136 patients met the inclusion criteria for this study. Among them, patients who underwent the modified Bentall procedure using the cuff wrapping technique were included in the M-Bentall group (n=46), while patients who underwent the classic Bentall (C-Bentall) procedure were categorized into the C-Bentall group (n=90). To reduce baseline differences between the two groups, 1:1 nearest-neighbor propensity score matching (PSM) was performed. Demographic and perioperative data were documented and compared between the two groups.
Ninety patients were successfully matched (45 pairs). In-hospital mortality was not significantly different between the two groups after PSM (P=1). No differences were found in serious adverse events. The cardiopulmonary bypass (CPB) time was longer in the M-Bentall group than in the C-Bentall group (154 126 min, P=0.018). The same was also observed for the aortic cross-clamp time (113 92 min, P=0.009). Postoperatively, the peak value of D-dimer showed a significant difference, with higher values in the C-Bentall group (4.73 2.89 mg/L, P=0.019). The incidence of postoperative contrast extravasation at the aortic root (P=0.030) was higher in the C-Bentall group. The incidence of persistent aortic-right atrial shunts showed an increased tendency in the C-Bentall group (8.89% 0%, P=0.117).
The cuff wrapping technique is a safe and effective method to facilitate hemostasis of the aortic root in the modified Bentall procedure.
本研究旨在评估我们改良的带袖套包裹法Bentall手术（M-Bentall）的临床效果，该手术采用带袖套包裹技术处理残留的主动脉根部组织。
2017年7月至2021年12月，共有136例患者符合本研究的纳入标准。其中，采用带袖套包裹技术行改良Bentall手术的患者纳入M-Bentall组（n = 46），而行经典Bentall手术（C-Bentall）的患者归入C-Bentall组（n = 90）。为减少两组间的基线差异，进行了1:1最近邻倾向评分匹配（PSM）。记录并比较两组的人口统计学和围手术期数据。
90例患者成功匹配（45对）。PSM后两组的院内死亡率无显著差异（P = 1）。严重不良事件方面未发现差异。M-Bentall组的体外循环（CPB）时间长于C-Bentall组（154 ± 126分钟，P = 0.018）。主动脉阻断时间也有同样情况（113 ± 92分钟，P = 0.009）。术后，D-二聚体峰值有显著差异，C-Bentall组的值更高（4.73 ± 2.89mg/L，P = 0.019）。C-Bentall组主动脉根部术后造影剂外渗的发生率更高（P = 0.030）。C-Bentall组持续性主动脉-右心房分流的发生率有增加趋势（8.89% vs 0%，P = 0.117）。
带袖套包裹技术是改良Bentall手术中促进主动脉根部止血的一种安全有效的方法。
