摘要目的 报道应用无支架全主动脉根部生物瓣膜进行全主动脉根部置换术(Bio-Bentall手术)的早、中期临床效果.方法 回顾2001年11月到2009年3月病例,317例接受Bio-Bentall手术,男196例,女121例；年龄17 ～ 94岁,平均(70.3±10.2)岁,大于75岁的患者97例.均应用MedtronicFreestyle无支架全主动脉根部生物瓣膜进行全主动脉根部置换.203例患者仅行全主动脉根部置换或者主动脉根部置换加升主动脉置换(ARR),114例同期行其他手术(ARR+),其中冠状动脉旁路移植术82例,主动脉弓置换术36例,二尖瓣成形术11例.结果 ARR手术(190±57) min,主动脉阻断( 88±27) min.ARR+手术(282±93) min,主动脉阻断(110 -32) min.手术死亡25例,占7.9％.ARR者死亡11例,占5.4％；住ICU(4.9 ±8.1)天,住院(9.8±8.1)天.ARR组3例紧急行冠状动脉旁路移植手术.术后超声心动图显示跨瓣膜压力阶差低,尤其行间断单纯缝合(非褥式缝合)者压差更小.结论 Bio-Bentall手术保留了猪主动脉根部的完整性,不增加围术期和远期病死率,尤其适合小主动脉根部的老年主动脉瓣膜患者.

abstractsObjective The stentless full root aortic bioprosthesis has superior hemodynamics.Clinical data of Bio-Bentall procedure using stentless full root bioprosthesis of our center was retrospectively analyzed in this perspective for validation.Methods From November 2001 to March 2009,317 adult patients ( 196 male and 121 female) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement.Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement (ARR).In 114 patients a variety of concomitant procedures including coronary artery bypass grafting ( n =32 ),mitral valve repair ( n =11 ) and aortic arch replacement ( n =36 ) were performed.(ARR + ).Results Mean patient age was (70.3 ± 10.2) years (range 17 -94 years),97 patients were 75 and older at time of procedure.Mean operative time for the ARR was ( 190 ± 57 ) min with a clamp time of 88 - 27 min.Mean operative time for ARR + group was (282 ±93) min with an average clamp time of (110 ±32) min.Overall operative mortality was 7.9％ (25/317),for ARR it was 5.4％ (11/203 ).Mean ICU stay was (4.9 ± 8.1 ) days,mean hospital stay being (9.8 ± 8.1 ) days.Necessity for bailout bypass surgery among patients with ARR was low at 1.5％ (3/203) comparable to stented xenograft implantations.Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used.Conclusion Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/ascending aorta surgery.Though technically a more challenging operation,it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology.