[三分支主动脉弓支架型人工血管置入术在急性Stanford A型主动脉夹层外科治疗中的应用]
[The application of triple branches aortic arch stent-graft placement in the surgical treatment of acute Stanford type A aortic dissection].
作者信息
Hua Fei, Shen Zhen-ya, Yu Yun-sheng, Ye Wen-xue, Huang Hao-yue
机构信息
Department of Cardiovascular Surgery, Soochow University, Suzhou, China.
出版信息
Zhonghua Wai Ke Za Zhi. 2011 Aug 1;49(8):720-3.
OBJECTIVE
To sum up the experience of performing ascending aorta replacement combined triple-branched stent graft implantation for acute Stanford type A aortic dissection.
METHODS
From January 2010 to December 2010, 14 patients with acute Stanford type A aortic dissection underwent the procedure of performing ascending aorta replacement combined triple-branched stent graft implantation. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. When the body temperature drops below 18°C, the ascending aorta was transected near the base of the innominate artery. From the incision, the triple-branched stent graft was implanted into the true lumen of the arch, descending aorta and the aorta bifurcation vessel. The transected stump of the ascending aorta was anastomosis to the proximal of the branched blood vessel prosthesis.
RESULTS
Cardiopulmonary bypass time was (186 ± 38) min, cross clamp time was (101 ± 27) min, and average selective cerebral perfusion and lower body arrest time was (39 ± 11) min. The in-hospital mortality was zero. One patient of transient postoperative neurologic dysfunction, one of acute renal failure, one of transient limbs disturbance, one of secondary thoracotomy operation, one of gastrointestinal hemorrhage and one of postoperative chylothorax were observed. CT angiography rechecked showed the position of the vascular stent were satisfactory and the blood flow of arterial branches stents were lucid. The false lumen of the aortic arch and descending aorta closed with thrombus or shrinked.
CONCLUSIONS
The patients required aortic arch to be reconstructed which had no main tearing of intima in the arch may be best candidates for this technique. Open triple-branched stent graft placement combined ascending aorta replacement is an effective means for aortic arch reconstruction in acute Stanford type A aortic dissection.
目的
总结升主动脉置换联合三分支支架型人工血管植入术治疗急性Stanford A型主动脉夹层的经验。
方法
2010年1月至2010年12月，14例急性Stanford A型主动脉夹层患者接受升主动脉置换联合三分支支架型人工血管植入术。采用右腋动脉插管建立体外循环并选择性脑灌注。当体温降至18℃以下时，在无名动脉根部附近横断升主动脉。经切口将三分支支架型人工血管植入主动脉弓真腔、降主动脉及主动脉分叉血管。将升主动脉横断残端与分支血管人工血管近端吻合。
结果
体外循环时间为（186±38）分钟，主动脉阻断时间为（101±27）分钟，平均选择性脑灌注及下半身停循环时间为（39±11）分钟。住院死亡率为零。观察到1例术后短暂性神经功能障碍、1例急性肾衰竭、1例短暂性肢体功能障碍、1例二次开胸手术、1例消化道出血及1例术后乳糜胸。CT血管造影复查显示血管支架位置满意，动脉分支支架血流通畅。主动脉弓及降主动脉假腔血栓形成或缩小闭合。
结论
主动脉弓无内膜主要撕裂且需行主动脉弓重建的患者可能是该技术的最佳适应证。开放置入三分支支架型人工血管联合升主动脉置换是急性Stanford A型主动脉夹层主动脉弓重建的有效手段。
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