Björk V O, Bergdahl L, Henze A
Thorac Cardiovasc Surg. 1979 Feb;27(1):24-30. doi: 10.1055/s-0028-1096214.
This paper reviews the early and late results of 36 operations for aneurysms of the ascending aorta. Cystic medial necrosis was the predominant cause of aneurysm formation (56%), followed by arteriosclerosis (25%), previous aortotomy (11%) and syphilitic aortitis (8%). Dissection was encountered in 42%. The ascending aorta was replaced by a tubular Darcron graft in 26 patients, whereas 10 underwent aneurysmorrhaphy. Additional procedures were aortic valve replacement (27), resuspension of the aortic commissures (4) and coronary ostial implantation into sinus-shaped composite Dacron graft (4). Hospital mortality (0--18 days) was 8/36 patients (22%), but higher with cystic medial necrosis (30%), dissection (33%), duration of ECC greater than 180 minutes (38%), graft replacement (44%), emergency operation (45%) and heart volume greater than 900 ml/m2 BSA (50%). Late mortality (average 3 years) was 29%, but higher with cystic medial necrosis (33%), following aortic valve replacement (36%) and during anticoagulation (47%). Late cumulative survival (average 3 years) was 47% for the entire series, but only 33% in the presence of cystic medial necrosis. The poor overall prognosis for patients with cystic medial degeneration was closely related to a high incidence of fatal anastomotic complications and late deaths from cerebral haemorrhage during anticoagulation. Radical exclusion of the diseased aortic wall and omission of long-term anticoagulation are therefore desirable in order to lower the mortality rate. Surgery concerns the aneurysm per se, the aortic incompetence and the coronary ostia. The sinus-shaped composite graft with a Björk-Shiley prosthesis at its base appears to be a promising device for such a procedure, which should be performed electively, following early diagnosis in order to prevent dissection and emergency operations.
本文回顾了36例升主动脉瘤手术的早期和晚期结果。囊性中层坏死是动脉瘤形成的主要原因（56%），其次是动脉硬化（25%）、既往主动脉切开术（11%）和梅毒性主动脉炎（8%）。42%的患者出现夹层。26例患者用涤纶人工血管置换升主动脉，而10例接受了动脉瘤缝扎术。附加手术包括主动脉瓣置换（27例）、主动脉瓣连合部重新悬吊（4例）以及将冠状动脉开口植入窦状复合涤纶人工血管（4例）。住院死亡率（0至18天）为8/36例患者（22%），但囊性中层坏死患者的死亡率更高（30%），夹层患者（33%），体外循环时间超过180分钟患者（38%），人工血管置换患者（44%），急诊手术患者（45%）以及心脏容积大于900ml/m²体表面积患者（50%）。晚期死亡率（平均3年）为29%，但囊性中层坏死患者的死亡率更高（33%），主动脉瓣置换术后患者（36%）以及抗凝期间患者（47%）。整个系列的晚期累积生存率（平均3年）为47%，但存在囊性中层坏死时仅为33%。囊性中层退变患者总体预后较差与致命性吻合口并发症的高发生率以及抗凝期间脑出血导致的晚期死亡密切相关。因此，为降低死亡率，理想的做法是彻底切除病变的主动脉壁并避免长期抗凝。手术涉及动脉瘤本身、主动脉瓣关闭不全和冠状动脉开口。底部带有Björk-Shiley人工瓣膜的窦状复合人工血管似乎是进行此类手术的一种有前景的装置，该手术应在早期诊断后择期进行，以防止夹层和急诊手术。
