上升性大动脉置换与大动脉膜再植入
W Harringer1, K Pethig, C Hagl
1Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. harringer@thg.mh-hannover.de
Circulation
|November 24, 1999
概括
在患有大动脉根动脉瘤的患者中,使用达克隆移植进行大动脉修复,在某些情况下显示出出色的耐用性. 在这些大动脉动脉瘤修复中,实现完美的门尖端协对于长期成功至关重要.
科学领域:
- 心血管外科心血管外科
- 大动脉外科手术
- 心脏门维修 心脏门维修
背景情况:
- 大动脉根动脉瘤往往需要大动脉的修复,以及上升大动脉的替换.
- 在达克隆移植中,本土大动脉再植入的长期耐用性仍然是争论的主题,原因是顶上的机械应力.
研究的目的:
- 评估大动脉根动脉瘤的达克朗管移植内本源大动脉再植入的耐用性和结果.
- 为了确定这一大动脉修复技术成功的关键因素.
主要方法:
- 75名患者的队列在1993年7月至1998年11月期间接受了上升性大动脉置换与大动脉修复.
- 随访包括每6至12个月间进行临床和心声学评估,累计为137个患者年.
- 包括Marfan综合征 (28%) 和大动脉剖析 (15%) 的患者;23%需要同时进行大动脉门置换.
主要成果:
- 没有观察到手术后死亡率. 晚期死亡发生在3%的患者中.
- 3%的患者需要在14个月内因渐进性大动脉功能不全而重新手术.
- 大多数患者 (超过96%) 没有或仅有轻度的大动脉缺陷,修复持续65个月 (平均22个月).
结论:
- 在达克隆移植中重新植入本源性大动脉是一种有效的治疗方法,用于选择患有大动脉根动脉瘤的患者.
- 细致的修复确保了完美的初始顶合和最小的或痕迹的大动脉缺陷对于持久的结果至关重要.
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