Tanaka Masashi, Kimura Naoyuki, Yamaguchi Atsushi, Adachi Hideo
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya, Saitama, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(1):18-23. doi: 10.5761/atcs.oa.11.01704. Epub 2011 Sep 15.
Our surgical strategies for acute type A aortic dissection (AAAD) are prompt establishment of cardiopulmonary bypass and primary entry resection. We investigated our experience with surgery for AAAD.
Between January 1997 and December 2006, 243 consecutive patients with AAAD underwent emergency surgery. Clinical and diagnostic data of these patients were analyzed retrospectively.
Surgical procedures included ascending aorta or hemiarch replacement (n = 212) and total or partial arch replacement (n = 31), and those for proximal reconstruction included modified Bentall procedure (n = 8), and aortic valve replacement (n = 3). Hospital mortality was 6.9%, and entry resection was performed in 74% of patients. Actuarial survival rate at 5 and 10 years was 86% ± 14% and 77% ± 23%, respectively. A total of 13 patients required re-operation: 5, an aortic root; 3, an aortic arch; and 5, a descending aorta. Actuarial freedom from re-operation at 5 and 10 years was 95% ± 5%, and 81% ± 18%, respectively.
Our surgical strategy for AAAD seems to be pertinent with acceptable short- and long-term results. Since we lost 8 patients due to rupture of false lumen postoperatively, careful follow-up for a residual false lumen may improve the patients' prognosis.
我们针对急性A型主动脉夹层（AAAD）的手术策略是迅速建立体外循环并进行原发破口切除。我们调查了我们在AAAD手术方面的经验。
在1997年1月至2006年12月期间，243例连续的AAAD患者接受了急诊手术。对这些患者的临床和诊断数据进行了回顾性分析。
手术方式包括升主动脉或半弓置换（n = 212）以及全弓或部分弓置换（n = 31），近端重建的方式包括改良Bentall手术（n = 8）和主动脉瓣置换（n = 3）。医院死亡率为6.9%，74%的患者进行了破口切除。5年和10年的精算生存率分别为86%±14%和77%±23%。共有13例患者需要再次手术：5例为主动脉根部，3例为主动脉弓，5例为降主动脉。5年和10年再次手术的精算无复发生存率分别为95%±5%和81%±18%。
我们针对AAAD的手术策略似乎是恰当的，短期和长期结果均可接受。由于我们有8例患者术后因假腔破裂死亡，因此对残余假腔进行仔细随访可能会改善患者的预后。
