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延迟两阶段Bentall手术:一种安全的再次人工主动脉根部置换技术:病例系列

Delayed Two-Stage Bentall Procedure: A Safe Technique of Redo Supra-Prosthetic Aortic Root Replacement: A Case Series.

作者信息

Makhoul Maged, Natour Nicole, Salmasi M Yousuf, Jainandunsing Jayant S, Słomka Artur, Lorusso Roberto, Bidar Elham, Natour Ehsan

机构信息

Cardiovascular Research Institute, Maastricht (CARIM), 6200 Maastricht, The Netherlands.

Cardiac Surgery Department, Rambam Medical Center, Haifa 3525408, Israel.

出版信息

J Clin Med. 2025 Aug 9;14(16):5638. doi: 10.3390/jcm14165638.

Abstract

Patients presented for complicated redo surgery after previous aortic valve replacement with the indication for aortic root repair due to dilatation or aneurysm. In those cases where the prosthetic aortic valve is in good condition, a valve-sparing procedure might simplify the complicated surgery. The aim of this case series paper is to describe a technique and to show the results of repairing the aortic root without compromising the previously inserted, well-functioning mechanical aortic valve. Between March 2017 and May 2017, 11 patients underwent re-sternotomy with placement on cardiopulmonary bypass with cardiac arrest and exposure of the aortic root. After the aortotomy, the aortic valve was inspected. Subsequently, the aortic sinuses were resected, sparing the coronary ostia buttons. A prosthetic tube was implanted above the preexisting valve. Finally, the coronary ostia were reattached to the tube, turning this procedure into a complete Bentall. Echocardiography demonstrated fully functional valves and well-implanted aortic prosthesis. All patients were discharged within ten days post-surgery without any adverse events. The delayed two-stage Bentall procedure is a feasible and safe technique that preserves pre-implanted valves and does not cause any distortion of the aortic annulus.

摘要

患者因先前主动脉瓣置换术后出现复杂的再次手术,因主动脉根部扩张或动脉瘤而有主动脉根部修复指征。在那些人工主动脉瓣状况良好的病例中,保留瓣膜的手术可能会简化复杂的手术。本病例系列论文的目的是描述一种技术,并展示在不影响先前植入的、功能良好的机械主动脉瓣的情况下修复主动脉根部的结果。2017年3月至2017年5月期间,11例患者接受了再次开胸手术,在心脏停搏和暴露主动脉根部的情况下进行体外循环。主动脉切开术后,检查主动脉瓣。随后,切除主动脉窦,保留冠状动脉开口纽扣。在原有瓣膜上方植入一个人工血管。最后,将冠状动脉开口重新连接到人工血管上,使该手术成为一个完整的Bentall手术。超声心动图显示瓣膜功能完全正常,主动脉人工血管植入良好。所有患者均在术后十天内出院,无任何不良事件。延迟的二期Bentall手术是一种可行且安全的技术,可保留先前植入的瓣膜,且不会导致主动脉瓣环任何变形。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/073b/12386327/9617e8a971c1/jcm-14-05638-g001.jpg

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