保留瓣膜的改良主动脉根部成形术治疗急性Stanford A型夹层的近中期效果观察

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Abstract Objective To investigate the early to middle term efficacy of modified aortic root plasty with valve sparing in the treatment of acute Stanford A dissection. Methods From January 2012 to December 2016, 32 patients were diagnosed for acute aortic dissection with Stanford A1 and A2 types in Department of Cardiothoracic Surgery, the First Affiliated Hospital of Nanjing Medical University. All patients were underwent the standard Sun's procedure. Modified aortic root plasty with valve sparing was applied in the root treatment. A fistulization was made with the adventitia wrapped around the artificial vessel and shunted to the right atrial appendage. Through the perioperative observation and postoperative follow up, disease progress, false lumen and thrombosis were all recorded. And the early-to-middle term results of the operation were assessed by comparing of preoperative and postoperative left ventricular ejection fraction (EF), left ventricular end diastolic diameter and aortic sinus diameter. Results There was no operation room death, but 4 deaths in the hospital. No serious complications such as paraplegia occurred. The discharged patients were followed up for 19-60 months. During the follow-up period, 2 patients died, 22 patients had complete thrombosis of the false lumen and 2 dilatations were observed in the descending thoracic aorta. There were no significant differences in the left ventricular EF [(56.4±6.7)% vs (59.1±8.2)%, P=0.700], left ventricular end diastolic dimension [(46.5±4.2) vs (46.9±5.7) mm, P=0.532] and aortic sinus diameter [(34.2±5.3) vs (35.5±6.1) mm, P=0.564] between the pre-operation and the last follow-up. Conclusion The pathological changes of acute aortic dissection involving the aortic root are complex. It is feasible to perform modified aortic root plasty with valve sparing in those without significant sinus extension and valve insufficiency. Improved success rate of operation and early to middle term clinical efficacy can both be achieved by the combination of accurate surgical suture and right-to-left shunt techniques.

Key words： Acute aortic dissection Stanford A Root plasty Early to middle term efficacy

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	ZHANG Dafa1
	2 CHEN Yijiang1 SHAO Yongfeng1 ZHANG Shijiang1 WEI Jun2

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ZHANG Dafa1,2 CHEN Yijiang1 SHAO Yongfeng1 ZHANG Shijiang1 WEI Jun2. Early to middle term efficacy of modified aortic root plasty with valve sparing in the treatment of acute Stanford A dissection[J]. 中国医药导报, 2017, 14(32): 55-58.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2017/V14/I32/55

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