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本组有6例年龄>50岁的患者，于术前进行CAG，明确无冠脉疾病后行手术治疗。严把CAG指证，可以明显降低围手术期因心肌梗死或低心排出量综合征所致的心脏终点事件的发生率。我们认为，CAG的指证为当患者年龄>50岁、有反复心绞痛发作、不稳定心绞痛者，均应于术前行该检查。如冠状动脉有确切病变，则为Bentall手术的禁忌证。术后1年随访结果提示，所有生存的患者其心功能均有了明显的改善。本组患者中随访30例除1例于术后10个月死亡外，其余患者心功能均恢复至Ⅰ-Ⅱ级，与其他学者报道的结果相似[3]。术后5年的随访结果提示，本组患者生存率为90.6%，略高于国外报道的81.5%的水平;术后远期的生存情况与出血或血栓形成有密切关系。本组术后出血发生率为3.1%，略高于Gott[9]等报道的水平，可能与术后患者口服抗凝药物及定期复查的依从性有关。
总之，Bentall手术是治疗升主动脉瘤合并主动脉瓣关闭不全的有效手段，该术式为患者提供了令人满意的近期及中-远期疗效。
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[7] Ferencik M, Pape LA. Changes in size of ascending aorta and aortic valve function with time in patients with congenitally bicuspid aortic valves[J]. Am J Cardio, 2006, 92:43-46.
[8] Yasuda H, Nakatani S, Stugaard M, et al. Failure to prevent progressive dilation of ascending aorta by aorticvalve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve[J]. Circulation, 2005, 108 (Suppl 1): Ⅱ 291-294.
[9] Gott VL, Gillinov AM, Pyeritz RE, et al.Aortic root replacement. Risk factor analysis of a seventeen-years experience with 270 patients[J]. J Thorac Cardiovasc Surg ,2008, 109(3): 536-545.
