[1]李畑波,刘宸铖,徐博,等.再次主动脉手术的重要病因——结缔组织病[J].陆军军医大学学报(原第三军医大学学报),2021,43(22):2449-2454.
 LI Tianbo,LIU Chencheng,XU Bo,et al.Connective tissue disease: an important cause of reoperation of aorta[J].J Amry Med Univ (J Third Mil Med Univ),2021,43(22):2449-2454.
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再次主动脉手术的重要病因——结缔组织病(/HTML )
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
43卷
期数:
2021年第22期
页码:
2449-2454
栏目:
临床医学
出版日期:
2021-11-30

文章信息/Info

Title:
Connective tissue disease: an important cause of reoperation of aorta
作者:
李畑波刘宸铖徐博王咏肖颖彬
陆军军医大学(第三军医大学)新桥医院心血管外科,全军心血管外科研究所
Author(s):
LI Tianbo LIU Chencheng XU Bo WANG Yong XIAO Yingbin
Department of Cardiovascular Surgery, PLA Institute of Cardiovascular Surgery, Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China
 
关键词:
心血管外科手术再次主动脉手术结缔组织病白塞氏病
Keywords:
cardiovascular surgery reoperation of aorta connective tissue disease Behcet&rsquos disease
分类号:
R181.32; R619; R654.3
文献标志码:
A
摘要:

目的探讨以结缔组织病为病因的再次主动脉手术的临床特点和外科治疗经验。方法回顾性分析2010年1月至2019年12月我科完成的45例再次主动脉手术患者的围手术期及随访资料。其中男性33例,女性12例,年龄9~73(46.0±14.1)岁。结缔组织疾病19例,包括白塞氏病9例、马凡氏综合征4例、主动脉瓣二叶畸形6例。再次行Bentall手术24例、Bentall+全主动脉弓置换术+降主动脉支架象鼻手术6例、Bentall+二尖瓣置换术5例、其他手术类型10例,术后连续随访17~113(58.5±25.6)个月。结果再次主动脉手术较为少见,仅占我科同期再次心血管外科手术的7.3%(45/617),而结缔组织病占其中的42.2%(19/45)。围手术期死亡5例,其中2例心脏骤停、2例持续性低心排综合征、1例顽固性低氧血症。随访过程中死亡7例,其中白塞氏病 4例,马凡氏综合征 1例,主动脉夹层术后2例;其余病例手术效果满意。Kaplan-Meier生存分析结果显示:随访期间白塞氏病死亡率最高(Log-rank检验,P=0.0082)。结论结缔组织病为再次主动脉手术的重要病因,其中白塞氏病术后死亡率最高、预后最差。

Abstract:
ObjectiveTo investigate the clinical characteristics and surgical treatment experience of reoperation of aorta caused by connective tissue disease. MethodsThe perioperative and follow-up data of 45 patients with reoperation of aorta in our department from January 2010 to December 2019 were collected and retrospectively analyzed. They were 33 males and 12 females, at an age from 9~73 (46.0±14.1) years. There were 19 cases of connective tissue disease, including 9 cases of Behcet’s disease, 4 cases of Marfan’s syndrome and 6 cases of bicuspid aortic valve. Bentall operation was performed in 24 cases, Bentall+total aortic arch replacement+descending aortic stent elephant trunk operation in 6 cases, Bentall+mitral valve replacement in 5 cases, and other types of operation in 10 cases. All the patients were followed up for 17~113 (58.5±25.6) months. ResultsReoperation of aorta was quite rare, only accounting for 7.3% of reoperation of cardiovascular surgeries in our department (45/617), while connective tissue disease took 42.2% (19/45) among the reoperation. There were 5 patients who died during perioperative period, including 2 cases due to cardiac arrest, 2 cases to persistent low cardiac output syndrome and 1 case to refractory hypoxemia. During the follow-up, 7 cases died, including 4 cases due to Behcet’s disease, 1 case to Marfan’s syndrome and 2 cases to aortic dissection. The outcomes of other cases were satisfactory. Kaplan-Meier survival analysis indicated the mortality rate of Behect’s disease was the highest during follow-up period (Log rank test, P=0.0082). ConclusionConnective tissue disease is an important cause of aortic reoperation. Behcet’s disease has the highest mortality and the worst prognosis.
 

参考文献/References:

[1]ANTONIOU A, BASHIR M, HARKY A, et al. Redo proximal thoracic aortic surgery: challenges and controversies[J]. Gen Thorac Cardiovasc Surg, 2019, 67(1): 118-126. DOI: 10.1007/s11748-018-0941-y.
 
[2]LEE I, PARK S, HWANG I, et al. Cardiac Behcet disease presenting as aortic valvulitis/aortitis or right heart inflammatory mass: a clinicopathologic study of 12 cases[J]. Am J Surg Pathol, 2008, 32(3): 390-398. DOI: 10.1097/pas.0b013e31814b23da.
 
[3]BECATTI M, EMMI G, SILVESTRI E, et al. Neutrophil activation promotes fibrinogen oxidation and thrombus formation in behet disease[J]. Circulation, 2016, 133(3): 302-311. DOI: 10.1161/circulationaha.115.017738.
 
[4]RAE S A, VANDENBURG M, SCHOLTZ C L. Aortic regurgitation and false aortic aneurysm formation in Behet’s disease[J]. Postgrad Med J, 1980, 56(656): 438-439. DOI: 10.1136/pgmj.56.656.438.
 
[5]MA W G, ZHENG J, ZHU J M, et al. Aortic regurgitation caused by Behcet’s disease: surgical experience during an 11-year period[J]. J Cardiac Surg, 2012, 27(1): 39-44. Erratum appears in 2012, 27(3): 403. DOI: 10.1111/j.1540-8191.2011.01392.x. 
 
[6]GHANG B, KIM J B, JUNG S H, et al. Surgical outcomes in Behcet’s disease patients with severe aortic regurgitation[J]. Ann Thorac Surg, 2019, 107(4): 1188-1194. DOI: 10.1016/j.athoracsur.2018.08.040.
 
[7]JEONG D S, KIM K H, KIM J S, et al. Long-term experience of surgical treatment for aortic regurgitation attributable to Behcet’s disease[J]. Ann Thorac Surg, 2009, 87(6): 1775-1782. DOI: 10.1016/j.athoracsur.2009.03.008.
 
[8]AZUMA T, YAMAZAKI K, SAITO S, et al. Aortic valve replacement in Behcet’s disease: surgical modification to prevent valve detachment[J]. Eur J Cardiothorac Surg, 2009, 36(4): 771-772. DOI: 10.1016/j.ejcts.2009.05.031.
 
[9]HATEMI G, CHRISTENSEN R, BANG D, et al. 2018 update of the EULAR recommendations for the management of Behcet’s syndrome[J]. Ann Rheum Dis, 2018, 77(6): 808-818. DOI: 10.1136/annrheumdis-2018-213225.
 
[10]RAMIREZ F, DIETZ H C. Marfan syndrome: from molecular pathogenesis to clinical treatment[J]. Curr Opin Genet Dev, 2007, 17(3): 252-258. DOI: 10.1016/j.gde.2007.04.006.
 
[11]GREWAL N, GROOT G. Pathogenesis of aortic wall complications in Marfan syndrome[J]. Cardiovascular Pathology, 2018, 33: 62-69. DOI: 10.1016/j.carpath.2018.01.005. 
 
[12]SCHOENHOFF F S, JUNGI S, CZERNY M, et al. Acute aortic dissection determines the fate of initially untreated aortic segments in Marfan syndrome[J]. Circulation, 2013, 127(15): 1569-1575. DOI: 10.1161/CIRCULATIONAHA.113.001457.
 
[13]FINKBOHNER R, JOHNSTON D, CRAWFORD E S, et al. Marfan syndrome. Long-term survival and complications after aortic aneurysm repair.[J]. Circulation, 1995, 91(3): 728-733.
 
[14]LEACCHE M, BYRNE J G. Type A aortic dissection in Marfan syndrome: a case for more aggressive and extensive surgery at the time of the initial surgical operation[J]. Circulation, 2014, 129(13): 1373-1374. DOI: 10.1161/circulationaha.114.008745.
 
[15]RYLSKI B, BAVARIA J E, BEYERSDORF F, et al. Type A aortic dissection in Marfan syndrome: Extent of initial surgery determines long-term outcome[J]. Circulation, 2014, 129(13): 1381-1386.
 
[16]NORDON I M, HINCHLIFFE R J, HOLT P J, et al. Endovascular management of chronic aortic dissection in patients with Marfan syndrome[J]. J Vasc Surg, 2009, 50(5): 987-991. DOI: 10.1016/j.jvs.2009.05.056.
 
[17]PIERPONT M E, BRUECKNER M, CHUNG W K, et al. Genetic basis for congenital heart disease: revisited: a scientific statement from the American Heart Association[J]. Circulation, 2018, 138(21): e653-e711. DOI: 10.1161/CIR.0000000000000606.
 
[18]SIU S C, SILVERSIDES C K. Bicuspid aortic valve disease[J]. J Am Coll Cardiol, 2010, 55(25): 2789-2800. DOI: 10.1016/j.jacc.2009.12.068.
 
[19]PEPE G, NISTRI S, GIUSTI B, et al. Identification of fibrillin 1 gene mutations in patients with bicuspid aortic valve (BAV) without Marfan syndrome[J]. BMC Med Genet, 2014, 15: 23. DOI: 10.1186/1471-2350-15-23.
 
[20]GIRDAUSKAS E, DISHA K, ROUMAN M N, et al. Aortic events after isolated aortic valve replacement for bicuspid aortic valve root phenotype: echocardiographic follow-up study[J]. Eur J Cardio Thorac Surg, 2015, 48(4): e71-e76. DOI: 10.1093/ejcts/ezv259.
 
[21]刘凌超, 唐富琴, 李畑波, 等. 主动脉瓣二叶畸形行主动脉瓣置换术后疗效的中期随访研究——基于倾向性评分匹配法分析[J]. 第三军医大学学报. 2021. 43(02): 101-108. DOI: 10.16016/j.1000-5404.202009112.
 
LIU L C, TANG F Q, LI T B, et al. Efficacy of aortic valve replacement for bicuspid aortic valve: a medium-term follow-up study based on propensity score matching analysis[J]. J Third Mil Med Univ, 2021, 43(2): 101-108. DOI: 10.16016/j.1000-5404.202009112.
 

更新日期/Last Update: 2021-11-23