Comparision of Inclusion TechnicRue with Open Technique in Patients with Bentall Procedures

Bentall수술에서 inclusion technique 과 open technique의 비교

  • 김정택 (연세대학교 심장혈관센타) ;
  • 문준호 (연세대학교 심장혈관센타, 인하대학교병원 흉부외과학교실, 노원을지병원 흉부외과)
  • Published : 1997.05.01

Abstract

To understand the clinical results of aortic root replacement with either inclusion or open technique, we analysed 53 patients who underwent replacement of the aortic root with composite graft between October,1980, and May, 1995. Annuloaortic ectasia was the most common indication for operation(29 patients), follwed by aortic dissection(22 patients). Among 53 patients, 19(35%) had Marfan syndrome. Three patients died during hospitalization (Mortality: 5.5%). The follow up was possible in 48 patients(Follow-up rate; 94%,mean duration;37 months). The actuarial survival rate at 24 months was 95% in open technique group, and 87% in inclusion technique group. Late complications developed in 10 patients. Dissecting aneurysm in the remaining aorta was noted in 3 patients with inclu ion 1,schnique, and a pseudoaneurysm from coronary artery anastomosis site developed in a patient with inclusion technique. In conclusion, there was no statistical differences in survival for 24 months between inclusion technique and open technique group. But late problems in the remaining aorta or death from unknown cause occurred with moderate frequency : careful follow-up after aortic root replacement thought to be important for long term survival.

1980년 10월부터 1995년 5월까지 대동맥근 치환을 받은 53명의 환자를 대상으로 inclusion technique(IT)과 open technique(OT)의 수술성적을 비교하였다 대동맥근 치환술의 원인으로 W군에서는 대동맥륜확장을 동반할 상3n대동맥 동맥류가 20례, 대동맥박리가 8례, 그리고 인공판막심내막염이 1례였다. 07군에서는 대동맥륜 가성동맥류가 1례 있었다. 수술방법으로 Bentall등이 기술한 방 확장이 9례, 대동맥박리가 14례, 상행대동맥 법 또: 약가 변형된 방법을 사용하였다. 수술사망은 W군에서 패혈증과 심실부정 맥으로 각각 1례가 사망하 o3고 07구에서는 출혈로 1례가 사망하였다. 만기합병증은 W군에서 8례 발생하였으며 Of군에서 2례 발생하다. 마기사망은 W군에서 7례,07군에서 1례 발생하였다. 12개월 event free는 W군과 07군에서 각각 87% 와 85%, 24개월 생존률은 각각 87% 와 95%로 W군이 24개월생존률이 약간 높았으나 두 군 간에 통계학적 이 유의성은 없었다. nan으로 대동맥륜확장을 동반한 상행대동맥류나 대동맥박리에서 composite valve를 이용한 대동맥근 치 화술으 마조할 만한 단기 수술결과를 보여주었으나 inclusionfwrap technique과 ope technique간에 통계학적으로 의미있는 차이는 발견할 수 없었다. 그러나 시간이 지남에 따라 prothesis와 관련된 만기 합병증의 빈도가 증가하기 때문에 수술 후 추적관찰에 대한 노력이 장기생존에 중요할 것으로 생각된다.

Keywords

References

  1. Thorax v.23 A technique for complete replacement of the ascending aorta Bental H;De Bono A
  2. Ann Thorac Surg v.38 Surgical treatment of ascending aortic aneurysm with aortic calve insufficiency McCready RA;Pluth JR
  3. J Thorac Cardiovasc Surg v.86 Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency Grey DP;David DA;Cooley DA
  4. Ann Thorac Surg v.53 Surgical treatment of aortic root aneurysms in 280 patients Lewis CT;Cooley DA;Murphy MC(et al)
  5. J Thorac Cardiovasc Surg v.103 an aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta David TE;Feindel CM
  6. J Thorac Cardiovasc Surg v.107 Aortic root relationships Kunzenlman KS;Grande KJ;David TE(et al)
  7. J Thorac Cardiovasc Surg v.109 Aortic root replacement-Risk factor analysis of a seventeen year experience with 270 patients Gott YL;Marc Gillinov A;Pyeritz RE(et al)
  8. J Thorac Cardiovasc Surg v.92 Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve Kouchukos NT;Marshall WG;Wedige-Strcher TA
  9. N Engl J Med v.314 Surgical treatment of ascending aorta in the Marfan syndrome Gott VL; Pyeritz RE;Magovern GJ;Cameron DE(et al)
  10. Ann Surg v.214 Sixteen-year experience with aortic root replacement Kouchoukos NT;Waering TH;Murphy SF(et al)
  11. J Thorac Cardiovasc Surg v.98 Surgical treatment of aneurysm and/ of dissection of the ascending aorta, transverse aortic, and ascending aorta nad transverse aortic arch Crawford ES;Svensson LG;Coselli JS
  12. J Thorac Cardiovasc Surg v.111 Aortic valve preservation in acute type A dissection : Is it Sound? von Segesser LK;Lorenzetti E;Laschat M(et al)
  13. Ann Surg v.164 Endo-aneurysmorrhaphy and Trearment of Aortic Aneurysm
  14. J Thorac Cardiovasc Surg v.81 Complete replacement of the ascending aorta with reimplantation of the coronary arteries Cabrol C;Pavie A;Gandjbakhch I