在双动脉门中门置换后的大动脉的演变:中期随访结果
Raffaele Giordano1, Shadi Hamameh1, Vincenzo Speranza1
1Department of Advanced Biomedical Sciences, Division of Cardiac Surgery, Federico II University, Naples, Italy.
Heart, lung & circulation
|January 20, 2026
概括
双大动脉 (BAV) 和上升大动脉直径为40-44毫米的患者在大动脉置换 (AVR) 期间不需要预防性大动脉置换. 支持对这些BAV患者进行定期随访的保守管理.
科学领域:
- 心脏病学 心脏病学
- 遗传性心脏病是一种先天性心脏病.
- 大动脉膜疾病 大动脉膜疾病
背景情况:
- 双动脉 (BAV) 是一种常见的先天性心脏缺陷.
- BAV经常与上升性大动脉扩张有关.
- 管理指南建议在动脉置换过程中,对于45毫米或更大的上升大动脉直径进行手术干预.
研究的目的:
- 评估在患有BAV和直径在40-44毫米之间的患者上升性大动脉直径的自然进展,进行大动脉置换.
- 为了确定保守的治疗方法是否适合这个患者群体.
- 为了评估大动脉扩张率,生存率和重复手术率,在患有BAV和上升大动脉直径为40-44毫米的患者中.
主要方法:
- 在2012年至2018年间,88名BAV患者接受了大动脉置换手术 (SAVR) 的回顾性观察研究.
- 根据手术前的上升大动脉直径分组患者:<40毫米 (第一组) 和40-44毫米 (第二组).
- 至少5年的随访包括监测大动脉扩张,存活率和重新手术率.
主要成果:
- 两组之间没有观察到大动脉扩张率的显著差异 (0.2±0.07毫米/年).
- 生存率相似:第一组为86.3%,第二组为81.9%.
- 在随访期间,在两组中都不需要对大动脉剖析或动脉瘤进行重新手术.
结论:
- 接受AVR的BAV和上升大动脉直径为40-44毫米的患者可以通过定期监测进行保守的管理.
- 这些发现支持当前的指导方针,建议在这个范围内对上升性大动脉直径采取谨慎的方法.
- 在年轻患者或接近45毫米门的患者中,可以考虑预防性大动脉置换,以防止未来的并发症.
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