Huang F H, Li L P, Su C H, Qin W, Xu M, Wang L M, Jiang Y S, Qiu Z B, Xiao L Q, Zhang C, Shi H W, Chen X
Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing First Hospital, Nanjing Cardiovascular Disease Research Institute, Nanjing 210006, China.
Zhonghua Wai Ke Za Zhi. 2017 Apr 1;55(4):266-269. doi: 10.3760/cma.j.issn.0529-5815.2017.04.006.
To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun's procedure in 1 patient, Wheat combined with Sun's procedure in 1 patient, Bentall combined with Sun's procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun's procedure. Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were recovered after treatment. Thirteen patients were finally recovered from hospital. The patients were followed up for 16 to 45 months, and no aortic rupture, paraplegia and death were observed in the follow-up. Patients for residual aortic dissection after initial operations on Stanford type A aortic dissection should be attached great importance and always need emergency surgery, but the technique is demanding and risk is great for surgeons and patients, which need enough specification and accurate on aortic operation. More importantly, the Sun's procedure also should be performed on the treatment of residual aortic dissection or distal arch expansion, and obtains the short- and long-term results in the future.
总结既往接受斯坦福A型主动脉夹层手术的患者出现晚期并发症后再次手术的经验。2008年8月至2016年10月，南京医科大学附属南京医院胸心血管外科对14例既往因斯坦福A型主动脉夹层接受心脏手术的患者，针对其晚期并发症进行了再次手术。患者年龄范围为41至76岁，平均年龄为（57±12）岁。这些患者中，首次手术为升主动脉置换术3例，升主动脉联合部分主动脉弓置换术4例，马方综合征相关主动脉根部置换术（Bentall术）3例，主动脉瓣联合升主动脉置换术（Wheat术）1例，升主动脉联合孙氏手术1例，Wheat术联合孙氏手术1例，Bentall术联合孙氏手术1例。两次手术间隔时间平均为0.3至10.0年，平均为（4.8±3.1）年。再次手术的原因包括部分吻合口裂开、主动脉瓣关闭不全、假性动脉瘤形成、残余主动脉及假腔扩大。再次手术方式包括吻合口修复、主动脉瓣置换、全弓置换及孙氏手术。14例患者中，体外循环时间为107至409分钟，平均为（204±51）分钟，主动脉阻断时间为60至212分钟，平均为（108±35）分钟，选择性脑灌注时间为16至38分钟，平均为（21±11）分钟。所有患者手术存活，1例患者术后50天因严重肺部感染死亡。3例患者出现术后并发症，包括2例急性肾衰竭和1例肺部感染，经治疗后恢复。13例患者最终康复出院。对患者进行了16至45个月的随访，随访期间未观察到主动脉破裂、截瘫及死亡情况。对于初次手术治疗斯坦福A型主动脉夹层后残留主动脉夹层的患者应予以高度重视，往往需要急诊手术，但手术技术要求高，对术者及患者风险大，主动脉手术需要足够规范和精准。更重要的是，孙氏手术在残留主动脉夹层或远端主动脉弓扩张的治疗中也应开展，并在未来获得短期及长期疗效。
