Ando M, Kito Y, Takamoto S, Kosakai Y, Isobe F, Eishi K, Okita Y, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 May;44(5):606-13.
Among patients who underwent reconstruction of the aortic root by Bentall-type procedure using a composite graft, we investigated patients who underwent reoperation for complications related to composite graft. We employed composite graft reconstruction of the aortic root in 155 patients for 16 years prior to December 1994. Annulo-aortic ectasia was observed in 112 patients, aortic dissection in 34, and aortitis without aneurysm formation in 9. The original Bentall procedure was performed in 36, the Cabrol method in 8, the interposition method in 26, and the Carrel patch method in 85 patients. Thirteen (8.4%) of these patients required reoperation for complications related to the composite graft. Three of 4 patients with graft infection early after surgery underwent reconstruction with composite graft, but died in the hospital. The remaining patient survived after combined treatment that included the graft washing with Iodine (Isozin) solution and omentopexy. Four patients developed pseudoaneurysm formation due to sutural insufficiency and 7 has prosthetic valve failure as late complications. Three of the 4 patients with pseudoaneurysm underwent reconstruction with a second composite graft by the interposition method, while one patient with aortitis required another reoperation. In the remaining one patient, the leak was directly close along with second aortic valve replacement. All prosthetic valves used in 7 patients with prosthetic valve failure were Ionescu-Shiley biological valves. Primary tissue failure was observed in 6 and prosthetic valve endocarditis in one patient. Second cardiac valve replacement using a mechanical valve was possible. All the patients who underwent late reoperation showed favorable results. Infection of the composite graft showed the poor prognosis, and prevention of infection is important. Sutural insufficiency at the anastomosed site can be prevented by appropriate surgical procedures such as reinforcing suture, but further countermeasures for sutural insufficiency were considered necessary for aortitis in conditions, such as Behcet's diseases.
在采用复合移植物经Bentall式手术重建主动脉根部的患者中，我们对因复合移植物相关并发症而接受再次手术的患者进行了调查。在1994年12月之前的16年里，我们对155例患者采用复合移植物重建主动脉根部。其中，112例患者存在主动脉瓣环扩张，34例有主动脉夹层，9例有主动脉炎但未形成动脉瘤。最初采用Bentall手术的有36例，Cabrol法8例，置入法26例，Carrel补片法85例。这些患者中有13例（8.4%）因复合移植物相关并发症需要再次手术。4例术后早期发生移植物感染的患者中有3例接受了复合移植物重建，但均死于医院。其余1例患者经用碘（Isozin）溶液冲洗移植物和网膜固定术等联合治疗后存活。4例因缝合处不足形成假性动脉瘤，7例发生人工瓣膜功能障碍作为晚期并发症。4例假性动脉瘤患者中有3例采用置入法用第二个复合移植物进行重建，1例主动脉炎患者需要再次手术。在其余1例患者中，渗漏处直接缝合并同时进行第二次主动脉瓣置换。7例人工瓣膜功能障碍患者所用的所有人工瓣膜均为Ionescu-Shiley生物瓣膜。6例观察到原发性组织功能障碍，1例发生人工瓣膜心内膜炎。可以使用机械瓣膜进行第二次心脏瓣膜置换。所有接受晚期再次手术的患者均取得了良好效果。复合移植物感染预后较差，预防感染很重要。吻合部位的缝合不足可通过适当的手术操作如加强缝合来预防，但对于白塞病等情况下的主动脉炎，认为有必要针对缝合不足采取进一步对策。
