Murphy D A, Craver J M, Jones E L, Bone D K, Guyton R A, Hatcher C R
J Thorac Cardiovasc Surg. 1983 Feb;85(2):247-56.
This study retrospectively reviews the hospital records of 24 patients who developed ascending aortic dissection during or following 6,943 cardiac surgical procedures performed from January, 1971, through December, 1981. Group I consists of 15 patients with ascending aortic dissection presenting intraoperatively during myocardial revascularization. Group II consists of nine patients, seven who underwent myocardial revascularization and two who underwent aortic valve replacement, who developed ascending aortic dissection 30 minutes to 21 days after cardiac operation. Four of these patients had poorly controlled hypertension postoperatively. Surgical repair was attempted in all patients in Group I, with an operative mortality of 33%. The major cause of death was myocardial dysfunction secondary to ischemia. There were no operative deaths among six patients managed with closed plication techniques alone. Four of nine patients in Group II underwent ascending aortic dissection repair with an operative mortality of 50%. The overall mortality in Group II was 78%. The major factor in this high mortality was a delay in diagnosis and surgical therapy. Early diagnosis of the intraoperative or postoperative ascending aortic dissection process is essential to minimize the extent of dissection and prevent delay of definitive surgical therapy. Closed aortic plication of the intimal injury rather than more extensive aortic repair may reduce morbidity and mortality in selected patients.
本研究回顾性分析了1971年1月至1981年12月期间进行的6943例心脏外科手术中，24例发生升主动脉夹层的患者的医院记录。第一组包括15例在心肌血运重建术中出现升主动脉夹层的患者。第二组包括9例患者，其中7例接受了心肌血运重建术，2例接受了主动脉瓣置换术，他们在心脏手术后30分钟至21天发生了升主动脉夹层。这些患者中有4例术后高血压控制不佳。第一组所有患者均尝试进行手术修复，手术死亡率为33%。主要死亡原因是缺血继发的心肌功能障碍。仅采用闭合折叠技术治疗的6例患者中无手术死亡。第二组9例患者中有4例接受了升主动脉夹层修复，手术死亡率为50%。第二组的总体死亡率为78%。高死亡率的主要因素是诊断和手术治疗的延迟。术中或术后早期诊断升主动脉夹层过程对于最大限度地减少夹层范围和防止确定性手术治疗延迟至关重要。对于选定的患者，对内膜损伤进行主动脉闭合折叠而非更广泛的主动脉修复可能会降低发病率和死亡率。
