Ascending Aorta and Aortic Valve Replacement

Treatment of diseases: aortic regurgitation aortic stenosis Indication Ascending aorta and aortic valve replacement are suitable for ascending aortic aneurysm with aortic stenosis or regurgitation, but no aortic sinus is significantly enlarged, and no sinus tube boundary is significantly enlarged. Contraindications Severe liver, kidney, lung, brain insufficiency or intolerance to surgery. Preoperative preparation 1, preoperative special examination: preoperative aortic angiography, to determine the extent, location and pathological features of the lesion, as an important basis for the choice of surgical methods. MRI or spiral CT revascularization imaging techniques can also be used to determine the diagnosis of aneurysms. In patients with aortic regurgitation or coronary heart disease, left ventricular and coronary angiography should be performed at the same time as aortic angiography. 2, a comprehensive examination of the function of important organs: including heart, lung, liver, kidney function, etc., to determine whether there is no functional damage of important organs. 3, the discovery and treatment of chronic infections: such as periodontitis, chronic otitis media, urinary and reproductive system infections, chronic bronchitis. The above-mentioned chronic suppurative lesions should be properly treated and can be operated after being cured. 4, antibiotic application: thoracic aortic aneurysm surgery due to large wounds, need to do artificial blood vessel transplantation, in order to prevent postoperative infection, it is advisable to apply antibiotics before surgery. 5. In order to prevent bleeding and bleeding during and after surgery, platelets or fresh whole blood should be prepared. Aprotinin can be used during surgery. Surgical procedure 1, myocardial protection Because of the longer time of aortic occlusion, it is necessary to pay great attention to myocardial protection. Generally, the aortic aneurysm is perfused through the aortic root and directly perfused through the left and right coronary artery openings. Then switched to coronary sinus continuous reversal of cold blood cardioplegia. 2, replacement aortic valve For the first aortic valve replacement, the selected artificial valve type should not be too large, so as to avoid excessive local tension after the proximal artificial blood vessel anastomosis, affecting the coronary artery opening or causing local anastomotic bleeding. 3, artificial blood vessel transplantation can be first artificial anastomosis of the artificial blood vessel and the aorta, and then anastomosis proximal. When the wall of the aorta is weak or the wall of the aorta is weak, a strip of felt should be added to the wall of the aorta to prevent bleeding or tearing of the anastomosis. At the proximal end of the anastomosis, care should be taken to prevent damage to the coronary artery opening, especially when the proximal anterior wall anastomosis is performed, and the right coronary artery opening should be avoided. 4, the aortic aneurysm wall can be completely cut off or wrapped in protamine and heparin outside the artificial blood vessels, play a role in oppression and hemostasis.

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