本組有6例年齡>50歲的患者,于術(shù)前進行CAG,明確無冠脈疾病后行手術(shù)治療。嚴把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事件的發(fā)生率。我們認為,CAG的指證為當患者年齡>50歲、有反復心絞痛發(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至Ⅰ-Ⅱ級,與其他學者報道的結(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-遠期療效。
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