Sekine S, Abe T, Kuribayashi R, Seki K, Shibata Y, Yamagishi I, Matsukawa M
Department of Cardiovascular Surgery, Akita University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Jun;44(6):765-9.
Between February, 1982, and September, 1994, 24 patients underwent aortic root replacement using a valve-bearing composite graft and coronary perfusion grafts. The indications for surgery were annulo-aortic ectasia in 21 patients, and aortic dissection associated with significant aortic regurgitation in 3 patients. Aortic root was reconstructed employing the techniques described by Cabrol and colleagues (Cabrol operation) in 16, and by Piehler and Pluth (Piehler operation) in 8. Two of 16 patients who underwent Cabrol operation required concomitant procedures. Four patients (25.0%) who underwent Cabrol operation had technical troubles relating to coronary reattachements (kinking and torsion of coronary grafts in 2, obstruction of left limb of coronary graft in 1, and coronary graft compression by aortic wall wrapping in 1), while one patient (12.5%) having Piehler operation had coronary graft compression by partial wrapping of aortic root. The hospital deaths occurred in 4 patients undergone Cabrol operation, with the hospital mortality rate being 16.7%. Three patients including 2 with concomitant procedures died of low cardiac output and one died of rupture of residual dissecting aneurysm of the aortic arch. No pseudoaneurysm nor anastomotic stenosis was observed in any hospital survivors. Late deaths occurred in 5 patients, in whom there was no late complication relating to coronary reconstruction. However, late obstruction of left ostial stenosis developed in one patient who underwent Piehler operation, which required coronary artery bypass. We conclude that aortic root replacement using coronary perfusion grafts provides sound coronary anastomoses without late pseudoanurysm. Coronary reattachments is facilitated by use of Piehler technique, preventing coronary graft kinking or torsion. Late coronary ostial stenosis should be considered as a possible cause of fatal myocardial infarction and sudden death, and careful follow-up is required for patients having these kinds of operation for the prevention of late cardiac events.
1982年2月至1994年9月期间，24例患者接受了带瓣复合移植物和冠状动脉灌注移植物的主动脉根部置换术。手术适应证为21例患者的主动脉瓣环扩张，3例患者的主动脉夹层合并严重主动脉瓣反流。16例患者采用Cabrol及其同事描述的技术（Cabrol手术）重建主动脉根部，8例患者采用Piehler和Pluth描述的技术（Piehler手术）。16例接受Cabrol手术的患者中有2例需要同期进行其他手术。接受Cabrol手术的4例患者（25.0%）出现与冠状动脉重新吻合相关的技术问题（2例冠状动脉移植物扭结和扭曲，1例冠状动脉移植物左支阻塞，1例主动脉壁包裹压迫冠状动脉移植物），而1例接受Piehler手术的患者（12.5%）出现主动脉根部部分包裹压迫冠状动脉移植物。4例接受Cabrol手术的患者发生医院死亡，医院死亡率为16.7%。3例患者（包括2例同期进行其他手术的患者）死于低心排血量，1例死于主动脉弓残余夹层动脉瘤破裂。所有医院存活患者均未观察到假性动脉瘤或吻合口狭窄。5例患者发生晚期死亡，这些患者均无与冠状动脉重建相关的晚期并发症。然而，1例接受Piehler手术的患者发生左冠状动脉开口狭窄晚期阻塞，需要进行冠状动脉旁路移植术。我们得出结论，使用冠状动脉灌注移植物进行主动脉根部置换可提供可靠的冠状动脉吻合，且无晚期假性动脉瘤。使用Piehler技术有助于冠状动脉重新吻合，可防止冠状动脉移植物扭结或扭曲。应将冠状动脉开口晚期狭窄视为致命性心肌梗死和猝死的可能原因，对于接受此类手术的患者需要进行仔细随访，以预防晚期心脏事件。
