| Aortic valve disease(AVD)is one of the most serious lesions of valvular heart disease(VHD)it can lead to the continuous decline in the quality of life of patients,severe cases can cause death early.Aortic valve,mitral valve,tricuspid valve and pulmonary valve for the heart of the four valves,they maintain the normal physiological function of the heart,maintaining the blood from the left and right atrium to the left,right ventricle,left ventricular to the main Arterial,right ventricle to the pulmonary artery of the one-way flow.As a component of a dynamic structure,good heart valve function is a prerequisite for ensuring the forward flow of blood in the human body.Ascending aorta dilation(AAD)disease,is a serious threat to the lives of patients with macrovascular disease,its essence is the expansion or tear of the aortic lumen,can form a true aneurysm(TA),Pseudo aneurysm(FA)and aortic dissecting(AD),if the expansion of progressive increase,and ultimately lead to aortic rupture and death,surgical treatment is the main treatment.It can be said that there is a surge of aortic dilatation of the existence of the disease,like the patient’s body stored in a "time bomb",so that early detection and active surgical treatment is a key step,so as to greatly reduce the risk of death,its significance can not be ignored.After several years of development,surgical methods of aortic valve lesions combined with ascending aorta expansion are various,the methods include aortic valve replacement and ascending aortic replacement(mainly Bentall,David,Carbrol,Ross,Wheat,etc.),aortic valve replacement surgery and ascending aortic angioplasty;Some scholars believe that the ascending aorta expansion is not serious in patients with aortic valve replacement(AVR)alone,that solve the valve disease,Hemodynamics will return to normal,ascending aorta will not continue to expand.These procedures can be simply divided into three categories,that is,aortic valve replacement of the same period of ascending aortic angioplasty,aortic valve replacement with aortic dissection and simple aortic valve replacement surgery,these procedures have their own Advantages and disadvantages,and the international community is currently no uniform application standards.How do we know whether the treatment effects and the prognosis of these procedures are good or poor for the disease of aortic valve lesions combined with ascending aorta expansion and how should we choose the different surgical procedures.With these problems,we retrospectively analyzed patients from January 2012 to October 2016,due to aortic valve disease combined with ascending aorta dilation in the First Affiliated Hospital of Zhengzhou University,Cardiac Surgery for cardiac surgery.Comparison of these three different surgical procedures(aortic valve replacement with aortic aortic replacement,aortic valve replacement with aortic aortic angioplasty and simple aortic valve replacement surgery),through analysis,study and discuss the aortic valve lesions combined with ascending aorta expansion of the specific treatment program,the timing of surgery,surgical methods,treatment and follow-up results.Clinical treatment and follow-up of aortic valve disease complicated with ascending aorta dilation Objective:By comparing the aortic valve disease with ascending aorta dilatation in patients with aortic valve replacement in the same period ascending aortic replacement,or aortic valve replacement with aortic aorta formation,or simple aortic valve replacement after surgery Near mid-term efficacy,to explore how to choose the appropriate surgical approach.Methods:Retrospective analysis of our hospital in January 2012 to October 2016 during the aortic valve disease with ascending aorta dilation surgery patients.A total of 184 patients were enrolled in this study.Eight patients were sacrificed and 176 patients were enrolled.The patients underwent aortic dissection such as type I aortic dissection.A total of 53 patients underwent aortic valve replacement Aortic valve replacement in the same period of ascending aortic replacement for the B group,a total of 106 cases,a simple aortic valve replacement for the C group,a total of 17 cases,collected all selected patients name,age,sex,etiology(Bicuspid aortic valve,Marfan syndrome or trilobaloid aortic valve disease),combined disease(Coronary heart disease,hypertension,diabetes,infective endocarditis,aortic type II mezzanine),preoperative cardiac function grade(NYHA classification),preoperative and postoperative proximal aortic aorta diameter,preoperative and postoperative left ventricular ejection fraction(LVEF),concurrent surgery(Mitral or tricuspid valve surgery,coronary artery bypass surgery,partial bow replacement surgery,AF radiofrequency ablation,neoplasm),intraoperative aortic occlusion time,intraoperative cardiopulmonary bypass time,Postoperative second open chest number,postoperative hospital death and other clinical data.The changes of the aorta diameter and cardiac ejection fraction in the three groups were compared between the three groups in order to understand the near-term effect of the three groups of patients after the operation of the three groups.Statistical data: The data collected were analyzed by SPSS 21.0 statistical software,The categorical variables are expressed in terms of frequency and percentage,and the measurement data is expressed as(x ± s).The patients were divided into two groups according to the age,sex,etiology,comorbidities,preoperative cardiac function grade,preoperative and postoperative proximal aorta diameter,preoperative and postoperative cardiac ejection fraction,concurrent surgery,Off time,cardiopulmonary bypass time,postoperative second open chest number,postoperative hospital death and other clinical treatment,If the count data are subjected to the t-test,The comparison between groups was analyzed by one-way ANOVA(F-test)The rate of comparison usingχ2 test,P <0.05 for the difference was statistically significant.Results:There was no statistically significant difference in mean age between the three groups,the incidence of males was significantly higher in the three groups than in women.The difference of preoperative cardiac function grade,preoperative ascending aorta diameter,preoperative left ventricular ejection fraction,intraoperative aortic occlusion time,intraoperative cardiopulmonary bypass time,postoperative number of secondary thoracotomy cases,number of postoperative hospital deaths between the three groups was statistically significant.A group of postoperative hospital death in 1 case,B group of postoperative hospital death in 3 cases,C group of hospital without death,the main cause of death for malignant arrhythmia and low cardiac syndrome;There was no significant difference in the left ventricular ejection fraction between the first and third months after operation,and there was no significant difference between the three groups(P <0.05).The difference between the two groups was statistically significant Than in the mid-term were significantly decreased,the difference was statistically significant;follow-up of three groups were no aortic dissection and other malignant events.Conclusion:For aortic valve disease with ascending aortic dilatation,aortic valve replacement and ascending aortic angioplasty in the bicuspid aortic valve disease(BAV)or trilobaloral aortic valve disease after treatment near Good results,aortic valve replacement and ascending aortic replacement in the two-leaf or trilobaloral aortic valve and Marfan syndrome(MS)in the treatment of near-term good results,and surgery The degree of dilatation of the ascending aorta is lower than that of the ascending aorta after angioplasty.The use of simple aortic valve replacement in the treatment of the aortic valve-induced aortic valve disease and the proximal aorta of the ascending aorta can be achieved effect. |
