CAJ | 학술논문

目的总结心脏直视手术后A型主动脉夹层的治疗经验.方法 2009年2月至2011年12月,11例心脏直视手术后A型主动脉夹层的患者接受二次手术治疗,男8例,女3例;年龄29～64岁,平均(52.27±9.90)岁.首次心脏手术为主动脉瓣置换9例,室间隔缺损修补、房间隔缺损修补各1例.本次手术距首次手术1～26年.主动脉夹层的病理分型A1S型4例,A1C型1例,A2S型1例,A2C型4例,A3C型1例.结果 11例体外循环75～409 min,平均(185.36±99.67) min;主动脉阻断37～203 min,平均(84.09±48.36) min.6例深低温停循环、低流量选择性脑灌注患者低流量时间8～ 32 min,平均(17.71±9.48) min.死亡1例(9％);术后并发症3例(27％).生存患者随访16～45个月,随访期间无夹层破裂、截瘫和死亡.结论心脏直视手术后A型主动脉夹层患者应及时手术治疗,但手术难度及风险均较初次主动脉手术增加,因此进行心脏手术时应特别注意主动脉操作的规范和准确.对于主动脉瓣病变合并升主动脉扩张大于4.5cm的患者,应同期处理主动脉瓣和升主动脉,从而更有效地避免A型主动脉夹层及二次手术.
목적 총결심장직시수술후A형주동맥협층적치료경험.방법 2009년2월지2011년12월,11례심장직시수술후A형주동맥협층적환자접수이차수술치료,남8례,녀3례;년령29～64세,평균(52.27±9.90)세.수차심장수술위주동맥판치환9례,실간격결손수보、방간격결손수보각1례.본차수술거수차수술1～26년.주동맥협층적병리분형A1S형4례,A1C형1례,A2S형1례,A2C형4례,A3C형1례.결과 11례체외순배75～409 min,평균(185.36±99.67) min;주동맥조단37～203 min,평균(84.09±48.36) min.6례심저온정순배、저류량선택성뇌관주환자저류량시간8～ 32 min,평균(17.71±9.48) min.사망1례(9％);술후병발증3례(27％).생존환자수방16～45개월,수방기간무협층파렬、절탄화사망.결론 심장직시수술후A형주동맥협층환자응급시수술치료,단수술난도급풍험균교초차주동맥수술증가,인차진행심장수술시응특별주의주동맥조작적규범화준학.대우주동맥판병변합병승주동맥확장대우4.5cm적환자,응동기처리주동맥판화승주동맥,종이경유효지피면A형주동맥협층급이차수술.
Objective To summarize the experience of surgical repair for Stanford type A aortic dissection after cardiac surgery.Methods From February 2009 to December 2011,11 patients who underwent previous cardiac surgery accepted the aortic surgery for Stanford type A aortic dissection.There were 8 males and 3 females.The range of age was from 29 to 64 years,the mean age was(52.27±9.90) years.In these patients,one patient had underwent ventrical septal defect,one patient atrial septal defect,nine patients aortic valve replacement.The interval between the two operations was 1-26 years.The types of aortic dissection was A1S(4 patients),A1C(1 patient),A2S(1 patient),A2C(4 patients),A3C(1 patient).All the patients underwent aortic surgery for aortic dissection.Results The time of cardiopulmonary bypass was 75-409 minutes,the mean value was(185.36± 99.67) minutes.Aortic cross clamp time was 37-203 minutes,the mean value was (84.09± 48.36) minutes.Total six patients needed deep hypothermia and selective cerebral perfusion time was 8-32 minutes.The mean value was(17.71 ± 9.48) minutes.One patient dead in the hospital and the mortality was 9％.The morbidity was 27％.Ten patients followed up 16-45 months.No aortic rupture,paraplegia and death were observed in follow-up time.Conclusion The delayed Stanford type A aortic dissection after cardiac surgery should be attached great importance and always need emergency surgery to save patients' life.The technique is demanding and risk is great for surgeons and patients.For the patients who suffered aortic valve disease combined with dilation of ascending aorta larger than 4.5 cm,the ascending aorta also should be repaired while aortic valve replacement is performed,which could avoid delayed aortic dissection in the future.