Department of Cardiovascular Surgery, Xiamen Cardiovascular Hospital, Xiamen university, XiaMen, 361000, China.
J Cardiothorac Surg. 2020 Oct 21;15(1):322. doi: 10.1186/s13019-020-01306-9.
Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes.
From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge.
Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling.
The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.
急性斯坦福 A 型主动脉夹层常导致患者死亡，死亡率高，需要紧急干预。挽救性手术旨在通过解决严重的主动脉瓣反流、心脏压塞、原发性撕裂、以及器官灌注不良，并尽可能预防近端和下游主动脉的迟发性夹层相关并发症来维持患者生命。不幸的是，目前还没有针对这种疾病的最佳标准治疗或技术。全主动脉弓置换加冷冻象鼻技术在治疗急性 A 型主动脉夹层中发挥着重要作用。我们旨在描述一种改良的象鼻技术，并报告其短期结果。
2018 年 2 月至 2019 年 8 月，16 例急性 Stanford A 型主动脉夹层患者在厦门心脏中心接受改良冷冻象鼻技术手术（男/女：9/7；平均年龄：56.1±7.6 岁）。记录并分析所有围手术期变量。我们测量了升主动脉、主动脉弓和降主动脉在肺动脉和腹主动脉分叉处的直径，并比较了入院时、出院时和出院后 3 个月的直径。
15 例（93.8%）患者有高血压。5 例（31.3%）患者的主撕裂位于主动脉弓小弯侧，9 例（56.3%）患者的主撕裂位于升主动脉，2 例（12.5%）患者未发现入口。14 例（87.6%）患者夹层延伸至髂动脉和降主动脉远端，2 例（12.5%）患者夹层延伸至降主动脉远端。体外循环（CPB）、阻断和顺行性脑灌注时间分别为 215.8±40.5、140.8±32.3 和 55.1±15.2 分钟。15 例（93.8%）患者行主动脉瓣修复术。1 例（6.3%）患者行 Bentall 手术，另 1 例（6.3%）患者行冠状动脉修复术。出院时各部位直径均大于入院时，除主动脉弓外。3 个月后，象鼻远端真腔直径增大，提示假腔血栓形成和/或主动脉重塑。
改良冷冻象鼻技术治疗急性 Stanford A 型主动脉夹层安全可行，可用于治疗器官灌注不良。短期结果令人鼓舞，但长期结果仍需进一步研究。
