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在急性A型大动脉剖析中使用"重塑技术"进行门节约性大动脉根置换后,失效率很高

Rainer G Leyh¹, Stefan Fischer, Klaus Kallenbach

¹Division of Thoracic and Cardiovascular Surgery, Hanover Medical School, Hanover, Germany. leyh@thg.mh-hannover.de

|October 2, 2002

概括

在急性A型大动脉剖析中进行门节约性大动脉根置换,结果不一. 大动脉根重新植入产生了有利的中期结果,而重塑的失败率很高,这使得人们对其在这个患者群体中的使用产生了质疑.

科学领域:

心血管外科心血管外科
胸部外科手术胸部外科手术
大动脉疾病管理管理

背景情况:

节性大动脉根置换 (VSARR) 是一种急性A型大动脉解剖的手术方法.
由于证据有限,VSARR在急性A型大动脉解剖中的长期结果仍在争论中.
本研究报告了作者在被诊断患有急性A型大动脉剖析的患者中使用VSARR的经验.

研究的目的:

评估急性A型大动脉剖析患者的门节约性大动脉根置换的早期和晚期结果.
为了比较两个VSARR技术的疗效:重塑和重新植入.
评估与大动脉相关的并发症和急性A型大动脉剖析VSARR后的再操作率.

主要方法:

一组30名患有急性A型大动脉解剖的患者在1995年8月至2000年11月期间接受了门节约性大动脉根置换.
采用了两种技术:大动脉根改造 (8名患者) 和大动脉根再植入 (22名患者).
评估结果包括早期/晚期死亡率,门相关并发症和重复手术.

主要成果:

平均随访时间为22.6个月. 30天死亡率为17% (5/29),晚期死亡率为4% (1/24).
三名患者 (在重塑后) 需要重新手术,因为急性大动脉反,原因是指导管脱落;一名患者 (在重新植入后) 需要重新手术,因为内心炎.
听力心脏成像随访显示,在其他患者中,无>1级大动脉吐.

结论:

大动脉根改造在急性A型大动脉剖析中表现出高失败率,引发了对其适用性的担忧.
大动脉根再植入为急性A型大动脉剖析提供了有利的中期结果.
在患有急性A型大动脉剖析的患者中,建议考虑使用再植入技术进行手术.

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