Hahn C, Tam S K, Vlahakes G J, Hilgenberg A D, Akins C W, Buckley M J
Cardiac Surgical Unit, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Ann Thorac Surg. 1998 Jul;66(1):88-91. doi: 10.1016/s0003-4975(98)00352-x.
Aortic root replacement in patients who have undergone previous aortic root replacement presents a formidable technical challenge, which may lead to increased surgical mortality.
We reviewed our experience from January 1989 through November 1995. Seven consecutive patients (6 men and 1 woman) underwent eight repeat aortic root replacements. Mean follow-up was 19 months. Previous root replacement had been performed with homograft in 1 patient, with a bioprosthetic valve composite graft in 1 patient, and with a mechanical valve composite graft in 6 patients. The techniques used at the previous procedures were the Cabrol technique (2 patients), Bentall technique (3 patients), and the coronary button technique (3 patients). Reoperation was indicated for pseudoaneurysm formation in 4 patients and for endocarditis in the others.
Aortic homografts were implanted in all patients with endocarditis and mechanical valve composite grafts were used in the others. In all reoperations, the coronary button technique was used. No procedures were done emergently. Concomitant procedures were performed in 2 patients, including mitral valve replacement and aortic arch aneurysm repair. One patient had recurrence of his endocarditis 36 months after operation because of continued intravenous drug use requiring a second successful homograft root replacement. There were no early deaths and one late death at 16 months after operation.
Repeat aortic root replacement, even in the setting of endocarditis, can be done with low mortality.
曾接受过主动脉根部置换术的患者再次进行主动脉根部置换术面临巨大的技术挑战，这可能导致手术死亡率增加。
我们回顾了1989年1月至1995年11月期间的经验。连续7例患者（6例男性和1例女性）接受了8次主动脉根部再次置换术。平均随访时间为19个月。先前的根部置换术1例使用同种异体移植物，1例使用生物人工瓣膜复合移植物，6例使用机械瓣膜复合移植物。先前手术采用的技术有卡布罗尔技术（2例患者）、本塔尔技术（3例患者）和冠状动脉纽扣技术（3例患者）。再次手术的指征为4例患者出现假性动脉瘤形成，其他患者为心内膜炎。
所有心内膜炎患者均植入主动脉同种异体移植物，其他患者使用机械瓣膜复合移植物。所有再次手术均采用冠状动脉纽扣技术。无急诊手术。2例患者同时进行了其他手术，包括二尖瓣置换术和主动脉弓动脉瘤修复术。1例患者术后36个月因持续静脉吸毒导致心内膜炎复发，需要再次成功进行同种异体移植物根部置换术。无早期死亡病例，术后16个月有1例晚期死亡。
即使在合并心内膜炎的情况下，再次进行主动脉根部置换术也可实现低死亡率。
