Wu Zhi-yong, Wang Zhi-wei, Mao Zhi-fu, Xia Jun, Zhang Zun-yan, Chen Xue-fen, Deng Hong-ping, Xu Peng, Li Luo-cheng
Department of Cardiovascular Surgery, Renmim Hospital of Wuhan University, Wuhan 430060, China.
Zhonghua Wai Ke Za Zhi. 2011 Mar 1;49(3):236-9.
To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey I thoracic aortic dissection.
From January 2006 to October 2010, 101 cases of DeBakey I aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of (49 ± 8) years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion.
The mean cardiopulmonary bypass time was (212 ± 40) min, mean myocardial occlusion time was (95 ± 16) min, mean circulatory arrest time was (42 ± 8) min. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia, acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78.9%. Seventy-one patients were followed up for 5 to 49 months, 50 cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery.
The modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey I thoracic aortic dissection was safe and effective, with less postoperative complications.
总结改良全主动脉弓置换加支架象鼻技术治疗DeBakey I型胸主动脉夹层的临床研究。
2006年1月至2010年10月，采用改良全主动脉弓置换加支架象鼻技术治疗101例DeBakey I型主动脉夹层，其中急诊手术73例。男76例，女25例，年龄21～77岁，平均（49±8）岁。术中升主动脉置换31例，Bentall手术29例，Wheat手术7例，David手术34例。同时在左锁骨下动脉对应位置开窗植入支架象鼻重建血供。采用双侧顺行脑灌注完成深低温停循环脑保护。
体外循环时间平均（212±40）分钟，心肌阻断时间平均（95±16）分钟，停循环时间平均（42±8）分钟。手术死亡1例，住院死亡5例，分别死于败血症、急性肾衰竭、偏瘫合并多器官功能衰竭。与选择性脑灌注相比，术后脑血管意外及短暂性神经功能障碍发生率降低。76例出院前行主动脉CTA检查，胸降主动脉夹层假腔闭合率为78.9%。71例患者随访5～49个月，50例行CTA复查，胸降主动脉夹层假腔闭合率为88.0%，无晚期死亡及再次手术。
改良全主动脉弓置换加支架象鼻技术治疗DeBakey I型胸主动脉夹层安全有效，术后并发症少。
