升主动脉成形术治疗二叶式主动脉瓣患者升主动脉扩张的效果分析

摘要

Objective:To analyze the therapeutic effects of reduction ascending aortoplasty (RAA) on bicuspid aortic valve (BAV) with ascending aortic dilatation.Methods:Two hundred and eight patients with BAV complicating ascending aortic dilatation who underwent aortic valve replacement (AVR) and RAA in Changhai Hospital were analyzed retrospectively from Jan 2006 to Dec 2015.The patients were divided into BAV group and tricuspid aortic valve (TAV) group according to the aortic valve.In BAV group, the patients were divided into <30 mm group and ≥30 mm group according to the target diameter of ascending aorta during the operation.Results:Post-operative mortality, complication rate, reoperation rate, and diameter of ascending aorta during follow-up had no significant difference between BAV and TAV group (all P>0.05).The diameter of ascending aorta during follow-up was significantly shorter and the degree of dilatation in ascending aorta was smaller at 5 and 9 years after operation in patients whose diameter of ascending aortas <30 mm during operation than those in patients whose diameter of ascending aorta ≥30 mm (all P<0.05).Conclusion:In patients with BAV complicating ascending aortic dilatation, BAV is not an adverse factor of RAA, and the medium-long term therapeutic effect is better if the target diameter of ascending aorta is controlled under 30 mm during RAA.%目的:探讨升主动脉成形术(reduction ascending aortoplasty, RAA)治疗二叶式主动脉瓣(bicuspid aortic valve, BAV)患者升主动脉扩张的临床效果.方法:回顾性分析2006年1月至2015年12月长海医院208例因主动脉瓣病变合并升主动脉扩张行主动脉瓣置换术(aortic valve replacement, AVR)联合RAA治疗患者的临床资料.根据患者主动脉瓣情况,分为BAV组和三叶式主动脉瓣(tricuspid aortic valve, TAV)组;在BAV组中,根据术中升主动脉的目标直径,将患者分为<30 mm组和≥30 mm组.结果:BAV组与TAV组的术后死亡率、并发症发生率、二次手术比例和随访升主动脉直径等指标差异无统计学意义(P均>0.05);BAV组术中升主动脉目标直径<30 mm组的随访升主动脉直径、术后5年和9年升主动脉扩张程度均明显小于术中升主动脉≥30 mm组(P均<0.05).结论:对于BAV合并升主动脉扩张的患者,BAV不是行RAA的不利因素,在RAA术中将升主动脉目标直径控制在30 mm以下,中远期疗效更好.