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本組有6例年齡>50歲的患者，于術(shù)前進(jìn)行CAG，明確無冠脈疾病后行手術(shù)治療。嚴(yán)把CAG指證，可以明顯降低圍手術(shù)期因心肌梗死或低心排出量綜合征所致的心臟終點(diǎn)事件的發(fā)生率。我們認(rèn)為，CAG的指證為當(dāng)患者年齡>50歲、有反復(fù)心絞痛發(fā)作、不穩(wěn)定心絞痛者，均應(yīng)于術(shù)前行該檢查。如冠狀動脈有確切病變，則為Bentall手術(shù)的禁忌證。術(shù)后1年隨訪結(jié)果提示，所有生存的患者其心功能均有了明顯的改善。本組患者中隨訪30例除1例于術(shù)后10個月死亡外，其余患者心功能均恢復(fù)至Ⅰ-Ⅱ級，與其他學(xué)者報道的結(jié)果相似[3]。術(shù)后5年的隨訪結(jié)果提示，本組患者生存率為90.6%，略高于國外報道的81.5%的水平;術(shù)后遠(yuǎn)期的生存情況與出血或血栓形成有密切關(guān)系。本組術(shù)后出血發(fā)生率為3.1%，略高于Gott[9]等報道的水平，可能與術(shù)后患者口服抗凝藥物及定期復(fù)查的依從性有關(guān)。
總之，Bentall手術(shù)是治療升主動脈瘤合并主動脈瓣關(guān)閉不全的有效手段，該術(shù)式為患者提供了令人滿意的近期及中-遠(yuǎn)期療效。
【參考文獻(xiàn)】
[1] Bentall H, De Bono A.A technique for complete replacement of the ascending aorta[J]. Thorax, 1968, 23: 338-339.
[2] Cabrol C, Pavie A, Gandjabakhch I, et al. Complete replacement of the ascending aorta with reimplantation of the coronary arteries[J]. J Thorac Cardiovasc Surg, 1981,81: 309- 315.
[3] Kouchoukos NT, Wareing TH, Murphy SF, et al. Sixteen-year experience with aortic root replacement: results of 172 operations[J]. Ann Surg ,1991, 214: 308- 320醫(yī).學(xué)全.在.線網(wǎng)站gydjdsj.org.cn.
[4] Judge DP, Dietz HC. Marfan’s syndrome[J]. Lancet, 2005, 366: 1965-1976.
[5] Gott VL, Gress PS, Alejo DE, et al. Relationship of the aortic root in patients with Marfan’s syndrome[J]. N Engl J Med, 2005, 340: 1370-1313.
[6] Svensson LG, Kim KH, Lytle BW, et al. Relationship of aortic crosssectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves[J]. J Thorac Cardiovasc Surg, 2007, 126: 892-893.
[7] Ferencik M, Pape LA. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves[J]. Am J Cardio, 2006, 92:43-46.
[8] Yasuda H, Nakatani S, Stugaard M, et al. Failure to prevent progressive dilation of ascending aorta by aorticvalve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve[J]. Circulation, 2005, 108 (Suppl 1): Ⅱ 291-294.
[9] Gott VL, Gillinov AM, Pyeritz RE, et al.Aortic root replacement. Risk factor analysis of a seventeen-years experience with 270 patients[J]. J Thorac Cardiovasc Surg ,2008, 109(3): 536-545.
