摘要：目的  研究使用人工血管片重建主动脉根部在A型主动脉夹层手术中应用效果，探讨采用该方法行主动脉根部重建的可行性，为外科手术者制定A型主动脉夹层手术方案提供借鉴。 方法  主动脉根部受累的A型主动脉夹层患者恢复其正常的主动脉根部几何结构可以通过以下几个步骤实现：首先去除近端假腔的血和血凝块，然后可以通过简单的主动脉瓣膜交界的重新悬吊恢复瓣膜正常的关闭功能；把1~3片泪滴珠状的人工血管片缝合固定到窦内的瓣环和主动脉壁上重建主动窦，最后原位将冠状动脉移植到相应人工血管片的开口上完成主动脉根部重建，恢复主动脉瓣的正常关闭功能和冠状动脉的正常供血。结果  29例主动脉根部受累的A型主动脉夹层患者（术前中度以上主动脉瓣关闭不全21例，占72.4%；急性主动脉夹层25例，占86.2%）主动脉根部的处理采用人工血管片重建主动脉根部。住院死亡2例，病死率为6.9%。住院期间29例患者未因复发严重的主动脉瓣关闭不全而需要再手术。出院前超声心动图检查显示无、轻度和中度主动脉瓣关闭不全患者分别为6、19和2例。对所有幸存者进行了（8.8±3.4）个月随访，随访期间，超声心动图结果基本保持不变。结论  主动脉根部受累的A型主动脉夹层患者主动脉根部的处理采用人工血管片重建主动脉根部是一种容易和有效可行的方法，有利于保存主动脉根部的正常的几何学结构，避免术中的主动脉根部出血，早期临床效果良好。

关键词：主动脉瓣；主动脉夹层；主动脉根部修复

Abstract: Objectives  We summarized the surgical outcomes of using vascular graft patches for aortic root reconstruction in type A aortic dissection and determined the feasibility of this technique to provide surgeons some guidelines in designing operation schemes for type A aortic dissection. Methods  The damaged root geometry of type A aortic dissection was restored by several steps as follows: First, blood and clots in the proximal false lumen were removed. Then the aortic valve insufficiency was corrected by a simple resuspension of the aortic commissures. One to three teardrop-shaped patches were sutured to aortic wall and valve ring inside the sinuses in order to reconstruct the aortic sinuses. Finally, the coronary buttons were connected to the holes in the corresponding patches, and the sufficiency of aortic valve and the blood supply of coronary artery were restored. Results  A total of 29 type A aortic dissection patients with root pathology [moderate or severe regurgitation in 20 (72.4%) patients, acute aortic dissection in 25 (86.2%) patients] underwent modified valve-sparing root reconstruction. Two patients died in hospital and the mortality was 6.9%. There was no patient requiring reoperation due to severe recurrent insufficiency. The echocardiography before discharge showed that no, mild or moderate aortic valve insufficiency was found in 6, 19 and 2 patients, respectively. During the follow-up, which was completed in all patients and averaged for (8.8±3.4) months, these echocardiographic findings remained unchanged. Conclusions  This primary results show that modified valve-sparing root reconstruction using vascular graft patches is an easy and feasible approach, which preserves the normal root geometry and prevents bleeding from the root. It provides excellent early clinical results.

Key words: aortic valve; aortic dissection; aortic root repair