Yacoub M H, Gehle P, Chandrasekaran V, Birks E J, Child A, Radley-Smith R
National Heart and Lung Institute at Imperial College of Science, Technology and Medicine, Harefield, Uxbridge, United Kingdom.
J Thorac Cardiovasc Surg. 1998 May;115(5):1080-90. doi: 10.1016/S0022-5223(98)70408-8.
There is still no agreement about the best method of dealing with malfunction of the aortic valve caused by aneurysm or dissection of the aortic root. The experience, rationale, and development of a valve-preserving technique introduced and used since 1979 is described.
During this period 158 patients (78% of all patients undergoing resection of aneurysm of the ascending aorta) were operated on using this technique. Their ages ranged from 2 to 72 years (mean 46.6 years). Of the patients 107 were male and 51 were female. A total of 68 patients had skeletal manifestations of Marfan's syndrome. The original disease was chronic aneurysm of the ascending aorta or root in 92 (58.2%), chronic dissection in 17 (10.8%), and acute dissection in 49 (31%) patients. One hundred eleven additional procedures were performed in 84 patients. In all there were five early deaths (4.6% +/- 2%) in the 109 patients with chronic aneurysm and one death in the 103 patients operated on electively (0.97% +/- 0.9%). Actuarial survival for patients operated on for chronic aneurysm was 93.3%, 88.0%, 79.0%, and 57.9% at 1, 5, 10, and 15 years and 96.8%, 91.2%, 82.0%, and 60.0% for those operated on electively. Actuarial survival for patients operated on for acute dissection was 72.8%, 63.4%, and 53.3% at 1, 5, and 10 years. The probability of needing reoperation was 3.0% +/- 2%, 11% +/- 0.5%, and 11% +/- 0.5% at 1, 5, and 10 years. There were no instances of infective endocarditis or thromboembolic complications except in two patients operated on early in the series who had cusp extension. No anticoagulants were used. Echocardiography showed reduction in left ventricular end-systolic and end-diastolic dimensions, which was maintained. At the end of follow-up trivial or no aortic regurgitation was demonstrated in 63.6%, mild to moderate in 33.3%, and severe in 3%.
Valve-sparing operations are possible in a large proportion of patients with aneurysms of the ascending aorta and the medium and long-term results are encouraging.
对于因主动脉根部动脉瘤或夹层导致的主动脉瓣功能障碍，目前仍未就最佳处理方法达成共识。本文描述了自1979年以来引入并应用的一种保留瓣膜技术的经验、原理及发展情况。
在此期间，158例患者（占所有升主动脉瘤切除术患者的78%）接受了该技术手术。他们的年龄从2岁至72岁不等（平均46.6岁）。其中男性107例，女性51例。共有68例患者有马方综合征的骨骼表现。原发病为升主动脉或根部慢性动脉瘤的患者有92例（58.2%），慢性夹层的患者有17例（10.8%），急性夹层的患者有49例（31%）。84例患者还进行了111次额外手术。在109例慢性动脉瘤患者中，共有5例早期死亡（4.6%±2%），在103例择期手术患者中有1例死亡（0.97%±0.9%）。慢性动脉瘤手术患者1年、5年、10年和15年的精算生存率分别为93.3%、88.0%、79.0%和57.9%，择期手术患者分别为96.8%、91.2%、82.0%和60.0%。急性夹层手术患者1年、5年和10年的精算生存率分别为72.8%、63.4%和53.3%。1年、5年和10年需要再次手术的概率分别为3.0%±2%、11%±0.5%和11%±0.5%。除了该系列早期手术的2例有瓣叶延伸的患者外，未发生感染性心内膜炎或血栓栓塞并发症。未使用抗凝剂。超声心动图显示左心室收缩末期和舒张末期内径减小，且持续存在。随访结束时，63.6%的患者显示轻度或无主动脉瓣反流，33.3%的患者为轻至中度反流，3%的患者为重度反流。
大部分升主动脉瘤患者可行保留瓣膜手术，中长期结果令人鼓舞。
