Lu S, Sun X, Hong T, Yang S, Song K, Lai H, Wang C
Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China -
J Cardiovasc Surg (Torino). 2015 Aug;56(4):519-24. Epub 2013 Jun 3.
This study aimed to evaluate the results of modified surgical strategies of total arch replacement using a four-branched arch graft, stented elephant trunk, and innovative organ protection method for acute type A aortic dissection.
Between August 2011 and December 2011, 21 patients with acute type A aortic dissection underwent modified total arch replacement using the four-branched arch graft technique. All 21 patients had emergency surgery. Five patients had undergone previous aortic or cardiac surgery. The operations were stented elephant trunk implantation in 17 patients, ascending aorta replacement in 21 patients, coronary artery bypass grafting in four patients, Bentall operation in two patients, and aortic valve replacement in one patient. Twenty-one operations were performed under deep hypothermic extracorporeal circulation, modified selective cerebral perfusion, and end-organ and spinal cord protection for arch reconstruction.
There was two in-hospital deaths (9.5%). No persisting neurologic deficits or paraplegia occurred in 21 patients. Cardiopulmonary bypass time was 177.9±37.8 minutes. Myocardial ischemic time was 110.3±29.3 minutes. ICU time was 8.8±6.9 days and in-hospital duration was 28.7±13.7 days. Ventilation time varied from 9 hours to 21 days. A tracheotomy was necessary in four patients. Mean follow-up was 7.3±1.7 months and all patients are still alive.
Modified total arch replacement using a four-branched arch graft with stented elephant trunk and innovative organ protection is a useful and safe alternative technique for the treatment of acute type A aortic dissection and the results are encouraging.
本研究旨在评估采用四分支主动脉弓移植物、带支架象鼻技术及创新的器官保护方法进行改良全主动脉弓置换术治疗急性A型主动脉夹层的效果。
2011年8月至2011年12月期间，21例急性A型主动脉夹层患者接受了采用四分支主动脉弓移植物技术的改良全主动脉弓置换术。所有21例患者均接受了急诊手术。5例患者曾接受过主动脉或心脏手术。手术包括17例带支架象鼻植入术、21例升主动脉置换术、4例冠状动脉搭桥术、2例Bentall手术和1例主动脉瓣置换术。21例手术均在深低温体外循环、改良选择性脑灌注以及用于主动脉弓重建的终末器官和脊髓保护下进行。
有2例住院死亡（9.5%）。21例患者均未出现持续性神经功能缺损或截瘫。体外循环时间为177.9±37.8分钟。心肌缺血时间为110.3±29.3分钟。重症监护病房（ICU）时间为8.8±6.9天，住院时间为28.7±13.7天。通气时间从9小时至21天不等。4例患者需要行气管切开术。平均随访时间为7.3±1.7个月，所有患者均存活。
采用带支架象鼻的四分支主动脉弓移植物及创新的器官保护进行改良全主动脉弓置换术是治疗急性A型主动脉夹层的一种有效且安全的替代技术，结果令人鼓舞。
