Journal of Chest Surgery

  • 제43권3호
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  • Pages.260-265
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  • 2010
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
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대동맥 근부 복합 인공 판막 도관 치환술에 관한 임상적 고찰

Clinical Study of Composite Valve Graft Replacement of the Aortic Root

  • 박권재 (동아대학교병원 흉부외과) ;
  • 우종수 (동아대학교병원 흉부외과) ;
  • 조광조 (동아대학교병원 흉부외과) ;
  • 방정희 (동아대학교병원 흉부외과) ;
  • 정상석 (동아대학교병원 흉부외과)
  • Park, Kwon-Jae (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital) ;
  • Woo, Jong-Soo (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital) ;
  • Cho, Gwang-Jo (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital) ;
  • Bang, Jung-Hee (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital) ;
  • Jeong, Sang-Seok (Department of Thoracic and Cardiovascular Surgery, Dong-A University Hospital)
  • 투고 : 2010.01.11
  • 심사 : 2010.03.23
  • 발행 : 2010.06.05
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초록

배경: 복합 인공 판막 도관(composite valve graft) 치환술은 다양한 대동맥 근부 질환들에 사용되어 왔다. 이 연구의 목적은 이 술기에 대한 중기 결과를 알아보는 데 있다. 대상 및 방법: 1992년부터 2009년까지 대동맥 근부 복합 인공 판막 도관 치환술을 받은 39명의 환자를 대상으로 후향적 조사를 하였다. 환자들의 평균 나이는 $49.2{\pm}16.4$세였고, 평균 추적 관찰 기간은 $64.2{\pm}53.4$개월이었다(최대 기간, 176개월). 결과: 4명(8.6%)의 병원 내 사망이 있었고 모두 응급 대동맥 박리인 경우였다. 4명의 만기 사망이 있었는데 2명은 잔류 대동맥류, 1명은 경막하 출혈, 1명은 판막 주위 역류가 원인이었다. 생존율은 각각 1년, 5년, 10년에 93.5%, 85.0%, 85.0%였다. 추적 관찰 기간 동안 3명의 환자에서 뇌혈관 사고가 발생하였고, 뇌혈관 사고로부터의 자유율은 각각 1년, 5년, 10년에 97.0%, 92.0%, 80.0%였다. 모든 뇌혈관사고는 출혈과 연관된 합병증이었다. 결론: 복합 인공 판막 도관을 이용한 대동맥 근부 치환술은 좋은 결과를 보여 왔다. 그러므로 이 술기는 다양한 대동맥 근부 질환의 치료에 좋은 방법이라 할 수 있다.

Background: A composite valve graft replacement has been used for a variety of aortic root diseases. The aim of this study was to evaluate the mid-term results of this technique. Material and Method: We conducted a retrospective analysis of aortic root composite valve graft replacements in 39 patients and these procedures were done at our institution between 1992 and 2009. The mean age of the patients was $49.2{\pm}16.4$ years. The mean follow-up was $64.2{\pm}53.4$ months (maximum: 176 months). Result: There were 4 hospital deaths (8.6%) due to emergency aortic dissection and 4 late deaths owing to several causes. The causes of late death were 2 ruptures of a remnant aneurysm, 1 subdural hemorrhage and 1 paravalvular leakage. The calculated survival rate was 93.5%, 85.0% and 85.0% at 1, 5 and 10 years, respectively. There were 3 cerebrovascular accidents during the follow up period. The rate of freedom from cerebrovascular accidents was 97.0%, 92.0% and 80.0% at 1, 5 and 10 years, respectively. All of these brain accidents were hemorrhage-related complications. Conclusion: A composite valve graft replacement of the aortic root was associated with favorable results. So, this technique seems to be a good method to treat various aortic root diseases.

키워드

참고문헌

  1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968;23:338-9 https://doi.org/10.1136/thx.23.4.338
  2. Hilgenberg AD, Akins CW, Logan DL, et al. Composite aortic root replacement with direct coronary artery implantaion. Ann Thorac Surg 1996;62:1090-5 https://doi.org/10.1016/0003-4975(96)00487-0
  3. Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ. Composite valve graft replacement of the proximal aorta: comparison of techniques in 348 patients. Ann Thorac Surg 1992;54:427-39 https://doi.org/10.1016/0003-4975(92)90432-4
  4. Cabrol C, Pavie A, Gandjbakhch I, et al. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach. J Thorac Cardiovasc Surg 1981;81:309-15
  5. Svensson LG. Approach for insertion of aortic composite valve grafts. Ann Thorac Surg 1992;54:376-8 https://doi.org/10.1016/0003-4975(92)91409-3
  6. Kouchoukos NT, Wareing TH, Murphy SF, Perrillo JB. Sixteen-year experience with aortic root replacement. Ann Thorac Surg 1991;214:308-20
  7. Gott VL, Gillinov AM, Pyeritz RE, et al. Aortic root replacement: risk factor analysis of a seventeen year experience with 270 patients. J Thorac Cardiovasc Surg 1995;109:536-45 https://doi.org/10.1016/S0022-5223(95)70286-5
  8. Biglioli P, Sala A, Spirito R, et al. Composite valve graft replacement of the ascending aorta and the aortic valve by a modified button technique: the influence of aortic pathology on early mortality and late survival. Eur J Cardiothorac Surg 1995;9:483-90 https://doi.org/10.1016/S1010-7940(95)80047-6
  9. Baek MJ, Na CY, Kim WH, et al. Composite valve graft replacement of the aortic root. Korean J Thorac Cardiovasc Surg 2002;35:102-12
  10. Dossche KM, Schepens MA, Morshuis WJ, Riviere AB, Knaepen PJ, Vermeulen FE. A 23-year experience with composite valve graft replacement of the aortic root. Ann Thorac Surg 1999;67:1070-7 https://doi.org/10.1016/S0003-4975(99)00162-9
  11. Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med 1999;340:1307-13 https://doi.org/10.1056/NEJM199904293401702
  12. Alexiou C, Langley SM, Charlesworth P, Haw MP, Livesey SA, Monro JL. Aortic root replacement in patients with Marfan’s syndrome: the Southamptom experience. Ann Thorac Surg 2001;72:1502-8 https://doi.org/10.1016/S0003-4975(01)02993-9
  13. Tsunekawa T, Ogino H, Matsuda H, et al. Composite valve graft replacement of the aortic root: Twenty-seven years of experience at One Japanase Center. Ann Thorac Surg 2008;86:1510-7 https://doi.org/10.1016/j.athoracsur.2008.07.051
  14. Kazui T, Yamashita K, Terada H, et al. Late reoperation for proximal aortic and arch complications after previous composite graft replacement in Marfan patients. Ann Thorac Surg 2003;76:1203-8 https://doi.org/10.1016/S0003-4975(03)00719-7
  15. Lemaire SA, DiBardino DJ, K$\"{o}$ksoy C, Coselli JS. Proximal aortic reoperations in patients composite valve grafts. Ann Thorac Surg 2002;74:S1777-80 https://doi.org/10.1016/S0003-4975(02)04152-8
  16. Lepore V, Larsson S, Bugge M, Mantovani V, Karlsson T. Replacement of the ascending aorta with composite valve grafts: long term results. J Heart Valve Dis 1996;5:240-6
  17. Pacini D, Ranocchi F, Angeli E, et al. Aortic root replacement with composite valve graft. Ann Thorac Surg 2003;76:90-8 https://doi.org/10.1016/S0003-4975(03)00265-0
  18. Svensson LG. Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention. Ann Thorac Surg 2002;74:1786-8 https://doi.org/10.1016/S0003-4975(02)04145-0
  19. Hagl C, Strauch JT, Spielvogel D, et al. Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event free survival? Ann Thorac Surg 2003;76:698-703 https://doi.org/10.1016/S0003-4975(03)00568-X
  20. Roselli EE, Pettersson GB, Blackstone EH, et al. Adverse events during reoperative cardiac surgery: frequency, characterization, and rescue. J Thorac Cardiovascular Surg 2008;135:316-23 https://doi.org/10.1016/j.jtcvs.2007.08.060
  21. Kirsh EW, Radu NC, Mekontso-Dessap A, Hillion MS, Loisance D. Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta. J Thorac Cardiovasc Surg 2006;131:601-8 https://doi.org/10.1016/j.jtcvs.2005.11.007
  22. Nakahira A, Shibata T, Sasaki Y, et al. Outcome after the modified Bentall technique with a long interposed graft to the left coronary artery. Ann Thorac Surg 2009;87:109-16 https://doi.org/10.1016/j.athoracsur.2008.10.008