Yamada O, Kazui T, Yamada A, Koshino T, Sakurada T, Ikeda K, Kawashima T, Sasaki A, Inoue N, Komatsu S
Department of Surgery (Section 2), Sapporo Medical College, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Feb;41(2):227-33.
Fifty four patients who had aneurysms (n = 35) or dissections (n = 19) associated with aortic regurgitation underwent the replacement of the ascending aorta and aortic valve by composite valve graft during 15-year period between September 1976 and December 1991. Of these, 49 (90.7%) patients had an annuloaortic ectasia and 26 (48.1%) had the Marfan syndrome. The methods of coronary artery reattachment to the graft were as follows: direct reattachment (original Bentall's technique) in 45 patients, aortic button technique (Carrel's patch technique) in 6, Cabrol's technique in 2 and Piehler's technique in 1 patients. Seven patients with a DeBakey type I dissection had concomitant replacement of the aortic arch with an aid of selective cerebral perfusion. The overall hospital mortality rate was 12.9%, and it has significantly decreased to 6.7% since we adopted a cold cardioplegia, preclotting the graft with albumin autoclave technique and coronary artery reattachment using conventional over-and-over and interrupted mattress sutures with pledgets during the last 10-years. The mean duration of follow-up period was 58.6 months. The actuarial survival rate at 10 years for all patients was 76.4%; for those with dissection, 78.4%; and for patients with Marfan syndrome, 70.4%. Reoperation for the prosthesis-related complications was necessary in only one patient, although operations on the remainder of aorta were required in 5 patients. Actuarial freedom from these operations at 10 years was 74.1%, but it was 69.3% for the subgroup with Marfan syndrome. The present data indicates that composite valve graft technique is an useful method for patients with aortic root aneurysms or dissections.
1976年9月至1991年12月的15年间，54例患有与主动脉瓣反流相关的动脉瘤（n = 35）或夹层（n = 19）的患者接受了复合瓣膜移植术以置换升主动脉和主动脉瓣。其中，49例（90.7%）患者患有主动脉瓣环扩张，26例（48.1%）患有马方综合征。冠状动脉重新附着于移植血管的方法如下：45例患者采用直接重新附着（原始的Bentall技术），6例采用主动脉纽扣技术（Carrel补片技术），2例采用Cabrol技术，1例采用Piehler技术。7例DeBakey I型夹层患者在选择性脑灌注辅助下同时进行了主动脉弓置换。总体医院死亡率为12.9%，自我们在过去10年中采用冷停搏、用白蛋白高压灭菌技术预凝移植血管以及使用传统的连续和间断褥式带垫片缝线进行冠状动脉重新附着后，死亡率已显著降至6.7%。平均随访期为58.6个月。所有患者10年的精算生存率为76.4%；夹层患者为78.4%；马方综合征患者为70.4%。仅1例患者因假体相关并发症需要再次手术，尽管另有5例患者需要对主动脉其余部分进行手术。10年时无需进行这些手术的精算自由度为74.1%，但马方综合征亚组为69.3%。目前的数据表明，复合瓣膜移植技术对于主动脉根部动脉瘤或夹层患者是一种有用的方法。
