Hsu Ron-Bin, Chen Jeng-Wei
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
J Card Surg. 2014 Sep;29(5):641-6. doi: 10.1111/jocs.12359. Epub 2014 Jun 16.
Suture line dehiscence and pseudoaneurysm formation is one of the leading causes of late reoperation after surgical repair of acute type A aortic dissection (AAD). A sandwich technique can affect the need of reoperation. We sought to assess the late outcomes (mortality and reoperation) of a modified reinforced sandwich technique in conventional AAD repair.
Retrospective review of 63 consecutive patients undergoing AAD repair between 2003 and 2013. Aortic anastomosis was performed with a modified reinforced sandwich technique using Hemashield strips and two-layer polypropylene continuous and interrupted mattress sutures.
Marfan syndrome was diagnosed in five (8%) and bicuspid aortic valve in three patients (5%). Twenty-one patients (33%) had preoperative cardiogenic shock necessitating inotropic support. Replacement of the ascending aorta with aortic valve preservation was performed in 58 (92%) and hemiarch replacement in five patients (8%). Four patients died during initial hospitalization, yielding a hospital mortality of 6%. Median follow-up duration was 73 months (range, 1-124). Kaplan-Meier survival rates were 94 ± 3%, 84 ± 5%, and 59 ± 11% at 1, 5, and 10 years. One patient (1.7%) required proximal reoperation 44 months after AAD repair because of progressive dilatation of the aortic root. No patient had severe aortic regurgitation or pseudoaneurysm after AAD repair. Actuarial freedom from reoperation at 1, 5, and 10 years was 100%, 97%, and 97%.
A reinforced sandwich technique was a good technique resulting in a low incidence of late reoperation and pseudoaneurysm formation.
缝线处裂开和假性动脉瘤形成是急性A型主动脉夹层（AAD）手术修复后再次手术的主要原因之一。三明治技术可能会影响再次手术的需求。我们旨在评估改良强化三明治技术在传统AAD修复中的远期疗效（死亡率和再次手术率）。
回顾性分析2003年至2013年间连续63例行AAD修复的患者。采用Hemashield条带及两层聚丙烯连续和间断褥式缝线的改良强化三明治技术进行主动脉吻合。
5例（8%）诊断为马凡综合征，3例（5%）为二叶式主动脉瓣。21例（33%）患者术前发生心源性休克，需要使用血管活性药物支持。58例（92%）患者行保留主动脉瓣的升主动脉置换术，5例（8%）行半弓置换术。4例患者在初次住院期间死亡，住院死亡率为6%。中位随访时间为73个月（范围1 - 124个月）。1年、5年和10年的Kaplan-Meier生存率分别为94±3%、84±5%和59±11%。1例患者（1.7%）在AAD修复后44个月因主动脉根部进行性扩张需要近端再次手术。AAD修复后无患者发生严重主动脉瓣反流或假性动脉瘤。1年、5年和10年的再次手术无事件生存率分别为100%、97%和97%。
强化三明治技术是一种良好的技术，可降低远期再次手术率和假性动脉瘤形成的发生率。
