Westaby S, Katsumata T, Freitas E
Department of Cardiac Surgery, Oxford Heart Centre, England.
Ann Thorac Surg. 1997 Oct;64(4):1108-12. doi: 10.1016/s0003-4975(97)00803-5.
We consider operative survival as the primary objective in acute type A dissection and believe that virtually all native aortic valves can be conserved. We sought to answer the question: "Does glue repair improve the long-term stability of proximal aortic repair?"
We retrospectively studied 64 patients with an acute type A dissection, an ascending aortic tear, and aortic regurgitation operated on by the same surgeon between 1988 and 1996. Three had Marfan's syndrome and 2 had a bicuspid valve. The valves in all patients without Marfan's syndrome were repaired with gelatin-resorcinol-formol glue. The valve and root were reinvestigated by echocardiography. Some patients underwent nuclear magnetic resonance imaging.
There were four hospital (6%) and three late deaths. Aortic root reoperation was required in 2 of the 60 survivors (3.3%) and operation on the distal aorta in 2. Root reoperations were required within 3 years. The remaining proximal repairs remained stable.
The native aortic valve can be conserved in most patients, and glue repair is durable. Simple root repair is associated with a low operative mortality.
我们将手术存活视为急性A型主动脉夹层的主要目标，并认为几乎所有的主动脉瓣都可以保留。我们试图回答这个问题：“胶水修复能否提高升主动脉修复的长期稳定性？”
我们回顾性研究了1988年至1996年间由同一位外科医生手术治疗的64例急性A型主动脉夹层、升主动脉撕裂和主动脉瓣关闭不全患者。其中3例患有马凡综合征，2例有二叶式主动脉瓣。所有非马凡综合征患者的瓣膜均用明胶-间苯二酚-甲醛胶水修复。通过超声心动图对瓣膜和主动脉根部进行再次检查。部分患者接受了核磁共振成像检查。
有4例（6%）住院死亡，3例晚期死亡。60例存活者中有2例（3.3%）需要进行主动脉根部再次手术，2例需要对主动脉远端进行手术。根部再次手术在3年内进行。其余的升主动脉修复保持稳定。
大多数患者的主动脉瓣可以保留，胶水修复效果持久。单纯的根部修复手术死亡率较低。
