Massimo C G, Presenti L F, Marranci P, Favi P P, Poma A G, Ponzalli M, Viligiardi R G
Department of Surgery, Ospedale di Careggi-Firenze, Florence, Italy.
Ann Thorac Surg. 1988 Oct;46(4):420-4. doi: 10.1016/s0003-4975(10)64656-5.
Fifty-four patients with acute type A aortic dissection were surgically treated with extended aortic resection. The age of the patients ranged from 22 to 75 years, and all of them were in very critical condition. In 50 patients, the resection extended from the aortic valve (included in 33) to the beginning of the descending thoracic aorta and in 4, from the valve (included in 3) to the aortic bifurcation. Deep hypothermia and circulatory arrest were employed during the aortic arch resection; inclusion of the graft at the end of procedure was done in 44 patients; in the others, the diseased aortic wall was excised. Early mortality was 20 +/- 6% (11/54). Nine deaths were due to persistence of the distal dissection. Acute type A aortic dissection with aortic valve insufficiency should be treated as an emergency with extended aortic resection. As far as control of bleeding and closure of distal dissection are concerned, the best results have been achieved when the diseased aortic wall has been completely excised.
54例急性A型主动脉夹层患者接受了主动脉扩大切除术。患者年龄在22岁至75岁之间，均病情危重。50例患者的切除范围从主动脉瓣（其中33例包括主动脉瓣）至胸降主动脉起始部，4例从主动脉瓣（其中3例包括主动脉瓣）至主动脉分叉处。在主动脉弓切除术中采用了深低温停循环；44例患者在手术结束时植入了移植物；其他患者则切除了病变的主动脉壁。早期死亡率为20±6%（11/54）。9例死亡是由于远端夹层持续存在。伴有主动脉瓣关闭不全的急性A型主动脉夹层应作为急症行主动脉扩大切除术。就控制出血和封闭远端夹层而言，完全切除病变的主动脉壁可取得最佳效果。
