Sun Xiangfei, Zhao Qi, Huo Yufeng, Zhou Jinfeng, Zhao Fen, Liu Yimin, Du Yonghai, He Songxiong, Liu Chao, Jiang Detian, Sun Wenyu
Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, China.
Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
J Cardiothorac Surg. 2020 May 20;15(1):106. doi: 10.1186/s13019-020-01156-5.
Aortic arch replacement in acute type A aortic dissection patients remains the most challenging cardiovascular operation. Herein, we described our modified Y-graft technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) technique, and assessed the short-term outcomes of the patients.
Between February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients underwent FAB while 28 patients underwent both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previously reported studies.
In the FAB group, two patients died due to pulmonary infection (30-day survival rate, 91.3%), and two patients were paralyzed from the waist down. Hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received respiratory support for more than 2-days and eight patients (34.8%) for more than 5-days. These follow-up results were comparable or better than the patients with traditional Y-graft technique. Furthermore, compared to the FAB group, the morbidity due to neurological dysfunction and acute renal failure was significantly reduced in the FAB+OSCA group. Moreover, the respiratory support, length of postoperative stay and ICU stay were shortened.
This study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients showed less surgical complications and favorable short-term outcomes after this surgery.
对急性A型主动脉夹层患者进行主动脉弓置换术仍然是最具挑战性的心血管手术。在此，我们描述了我们使用股动脉旁路（FAB）和一分钟全身循环停搏（OSCA）技术的改良Y型移植物技术，并评估了患者的短期结局。
2015年2月至2017年11月期间，51例急性A型主动脉夹层患者接受了主动脉弓置换术。其中，23例患者接受了FAB，28例患者同时接受了FAB和OSCA。记录术中数据和术后随访数据。传统Y型移植物技术患者的随访数据从先前报道的研究中收集。
在FAB组中，2例患者因肺部感染死亡（30天生存率，91.3%），2例患者腰部以下瘫痪。5例患者（21.7%）在出院前进行了血液透析。15例患者（65.2%）接受呼吸支持超过2天，8例患者（34.8%）接受呼吸支持超过5天。这些随访结果与传统Y型移植物技术患者相当或更好。此外，与FAB组相比，FAB+OSCA组神经功能障碍和急性肾衰竭的发病率显著降低。此外，呼吸支持、术后住院时间和重症监护病房住院时间缩短。
本研究阐明了FAB和OSCA技术在改良Y型移植物技术中的可行性。急性A型主动脉夹层患者术后手术并发症较少，短期结局良好。
