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【THORAC. CARDIOVASC. SURG.编译】主动脉瓣、升主动脉
Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta
Sioris T./David T.E./Ivanov J. et al. [Dr. T.E. David, Div.
Cardiovasc. Surg. Toronto G., Toronto, Ont., Canada] - J.
THORAC. CARDIOVASC. SURG. 2004, 128/2 (260-265)
Objectives We sought to compare the clinical profile and outcomes
of operations for aortic valve disease and ascending
aortic aneurysm in patients treated with aortic valve replacement
and supracoronary replacement of the ascending aorta
or composite replacement of the aortic valve and ascending
aorta (Bentall operation). Methods From 1990 through 2001,
133 patients had aortic valve replacement and supracoronary
replacement of the ascending aorta, and 452 patients had Bentall
operations. Aortic valve replacement and supracoronary
replacement of the ascending aorta was performed in patients
who had aortic valve disease and dilation of the ascending aorta,
whereas the Bentall operation was performed in patients with
aortic root abnormality and ascending aortic aneurysm. Mean
follow-upwas 4.6 ± 3.1 years and was 100% complete. Results
Patients who had aortic valve replacement and supracoronary
replacement of the ascending aorta were older (61 ± 13 vs 52
± 16 years, P < .001) and more likely to have aortic stenosis,
coronary artery disease, and mitral valve disease than those
who had Bentall operations. The use of mechanical valves was
equal in both groups (42% for aortic valve replacement and
supracoronary replacement of the ascending aorta and 43% for
the Bentall operation). Operative mortality was 5% for patients
undergoing aortic valve replacement and supracoronary
replacement of the ascending aorta and 4% for patients undergoing
the Bentall operation (P = .45). Survival at 10 years was
57% ± 8% for patients undergoing aortic valve replacement
and supracoronary replacement of the ascending aorta and 74%
± 4% for patients undergoing the Bentall operation (P = .04),
but the type of operation had no effect on survival. Older age,
moderate or severe left ventricular dysfunction, active endocarditis,
previous cardiac surgery, and coronary artery disease
were independent predictors of death. The freedom from reoperation
at 10 years was 95% ± 5% for patients undergoing
aortic valve replacement and supracoronary replacement of the
ascending aorta and 94% ± 3% for patients undergoing the
Bentall operation (P = .18). Reoperations were mostly because
of tissue valve failure or endocarditis. The risk of valve-related
complicationswas the same in both groups. No patient required
reoperation for aortic root aneurysm after having aortic valve
replacement and supracoronary replacement of the ascending
aorta. Conclusions Aortic valve replacement and supracoronary
replacement of the ascending aorta and the Bentall operation
provide comparable long-term results. The Bentall operation is
more appropriate for patients with aortic root abnormality and
a dilated ascending aorta, whereas aortic valve replacement and
supracoronary replacement of the ascending aorta is a perfectly
acceptable operation for patients with aortic valve disease, normal
or mildly dilated aortic sinuses, and a dilated ascending
aorta.
编译：
研究目的：为了比较患有主动脉瓣疾病和升主动脉瘤的病人进行主动脉瓣置换术、升主动脉冠状动脉置换术和升主动脉主动脉瓣联合置换术（Bentall operation).的临床全貌和结果。从1990到2001年，在方法上，有133名病人接收了主动脉瓣置换术、升主动脉冠状动脉置换术,452名病人接收了联合置换术（Bentall operation)。对于患有主动脉瓣疾病和升主动脉扩张的病人是有效的。而bentall置换术对于患有主动脉根部畸形和升主动脉瘤的病人是有效的。平均随访4.6 ± 3.1年，且100%完成随访。结果：进行主动脉瓣置换术、升主动脉冠状动脉置换术的病人年龄较接受bentall置换术的大(61岁±13 ，bentall术 52岁± 16 , P<0.001) 且更容易患有动脉狭窄、冠状动脉疾病以及二尖瓣疾病 ，但两组使用人工瓣膜的几率是相等的(主动脉瓣置换术、升主动脉的冠状动脉置换术组的几率为42%而bentall术组为43％)。病人进行主动脉瓣置换术、升主动脉的冠状动脉置换术的手术死亡率为5% 而进行bentall置换术的死亡率为4%（P＝0.45）。病人进行主动脉瓣置换术、升主动脉的冠状动脉置换术的10年生存率为57%±8％，而行bentall置换术的病人10年生存率为74%± 4%（P＝0.04）。但是手术的形式对于生存没有影响作用。高龄、中等或者严重的左室功能紊乱、活动性心内膜炎、心脏手术史、冠状动脉疾病是独立的死亡先兆。进行主动脉瓣置换术、升主动脉的冠状动脉置换术的病人10年内免受再次手术的几率是95%±5%，而行bentall置换术的病人10年内免受再次手术的几率是94%±3%（P＝0.18）。再次手术的主要原因是组织瓣膜的衰竭和心内膜炎。两组瓣膜相关的并发症的发生率是相等的。患主动脉根部动脉瘤的患者在行主动脉瓣置换术、升主动脉的冠状动脉置换术后不再需要再次手术。结论：主动脉瓣置换术、升主动脉的冠状动脉置换术以及bentall置换术提供了长期的可比较的结果。Bentall术更适合于主动脉根部异常和升主动脉的扩张；而主动脉瓣置换术、升主动脉的冠状动脉置换术对于患有主动脉瓣疾病，但主动脉窦正常或略有扩张以及升主动脉扩张的病人是很好的可选择的术式。
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作者:admin@医学,生命科学 2010-11-03 05:11
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