Otaki M
Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
J Med. 1994;25(1-2):113-20.
Ten patients (nine male and one female), ranging in age from 21 to 68 years, were operated on for total composite replacement of the ascending aorta and the aortic valve. Among them annulo-aortic ectasia was the most common indication (five patients), followed by annulo-aortic ectasia with aortic dissection (three patients), the aneurysm and aortic valve regurgitation associated with aortitis syndrome (one patient), and the syphilitic aneurysm and aortic valve regurgitation (one patient). In the first four patients, composite replacement was conducted according to the original procedure described by Bentall and DeBono (1986). The next six patients were treated according to the procedure modified by Cabrol et al. (1981). There were no operative deaths or complications during hospitalization. However, late complications occurred in two patients at 46 months and 15 months after surgery, respectively. Despite the repair on an urgent basis, one died of hepatic failure and the other died on the table with massive disruption. Eight late survivors remain in the New York Heart Association (NYHA) class 1 on an average of 4.3 years postoperatively. It is concluded that total replacement with a composite graft is feasible in all patients with low operative mortality, but this procedure needs a close follow-up because of the potential for anastomotic dehiscences.
10例患者（9例男性，1例女性）接受了升主动脉和主动脉瓣全复合置换手术，年龄在21岁至68岁之间。其中，主动脉瓣环扩张是最常见的适应证（5例），其次是主动脉瓣环扩张合并主动脉夹层（3例）、与大动脉炎综合征相关的动脉瘤和主动脉瓣反流（1例）以及梅毒性动脉瘤和主动脉瓣反流（1例）。前4例患者按照Bentall和DeBono（1986年）描述的原始手术方法进行复合置换。接下来的6例患者按照Cabrol等人（1981年）改良的手术方法进行治疗。住院期间无手术死亡或并发症发生。然而，分别在术后46个月和15个月有2例患者出现晚期并发症。尽管进行了紧急修复，但1例死于肝功能衰竭，另1例在手术台上因大出血死亡。8例晚期存活患者术后平均4.3年，纽约心脏协会（NYHA）心功能分级均为1级。结论是，对于所有患者，采用复合移植物进行全置换手术是可行的，手术死亡率较低，但由于存在吻合口裂开的可能性，该手术需要密切随访。
