Tang Yangfeng, Han Lin, Fan Xinli, Zhang Boyao, Zhang Jiajun, Xue Qin, Xu Zhiyun
Department of Cardiothoracic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
J Thorac Dis. 2020 Aug;12(8):4126-4131. doi: 10.21037/jtd-20-1048.
Surgical strategy for treating chronic type A dissection with small true lumen at the descending aorta has not been reported. In this retrospective study, we reviewed our experience of applying a two-stage procedure for treating chronic type A dissection with small true lumen at the descending aorta.
Between February 2016 and December 2019, seven patients suffering from chronic type A dissection with small true lumen at the descending aorta underwent this procedure. Preoperative computed tomographic angiography (CTA) was performed to carefully assess the diameter of the descending aorta, tear site, and visceral arteries. The interval between the two procedures is determined by the condition of the patients' recovery and illustration of postoperative CTA after the first stage procedure.
All patients underwent first- and second-stage procedures. No mortality was observed among the seven patients. One patient who had a transient neurological deficit after the first stage recovered completely before hospital discharge. In two patients, the diameter of the descending aorta was enlarged postoperatively after the first-stage procedure. The interval between the two procedures was 2-3 months. However, no adverse events, such as stroke, paraparesis, visceral malperfusion, and lower extremity malfunction, were observed.
The two-staged procedure for the repair of chronic type A dissection with small true lumen at the descending aorta is adaptable with low prevalence of mortality and complication.
降主动脉真腔较小的慢性A型主动脉夹层的手术策略尚未见报道。在这项回顾性研究中，我们回顾了应用两阶段手术治疗降主动脉真腔较小的慢性A型主动脉夹层的经验。
2016年2月至2019年12月，7例降主动脉真腔较小的慢性A型主动脉夹层患者接受了该手术。术前进行计算机断层血管造影（CTA）以仔细评估降主动脉直径、撕裂部位和内脏动脉。两阶段手术的间隔时间取决于患者的恢复情况以及第一阶段手术后术后CTA的显示情况。
所有患者均接受了第一阶段和第二阶段手术。7例患者均未观察到死亡。1例在第一阶段手术后出现短暂神经功能缺损的患者在出院前完全康复。2例患者在第一阶段手术后降主动脉直径术后增大。两阶段手术的间隔时间为2至3个月。然而，未观察到中风、截瘫、内脏灌注不良和下肢功能障碍等不良事件。
降主动脉真腔较小的慢性A型主动脉夹层修复的两阶段手术适应性良好，死亡率和并发症发生率较低。
