Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, 1187-299 Kaname, Tsukuba, Ibaraki, 300-2622, Japan.
J Cardiothorac Surg. 2021 Jan 11;16(1):11. doi: 10.1186/s13019-020-01381-y.
Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion.
The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications.
Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.
急性主动脉夹层（AAD）是一种危及生命的疾病，可导致冠状动脉、头臂血管或分支血管灌注不良，以及主动脉瓣关闭不全或主动脉破裂。高危或老年的 A 型急性主动脉夹层（TAAAD）患者的外科治疗死亡率仍然很高，此类患者的治疗仍存在争议。我们报告了一例成功治疗伴有交通假腔的 TAAAD 的病例，该患者为急性半脑灌注不良的 60 岁男性。
升主动脉采用逐步外部包裹（SEW）术进行包裹，随后成功进行了胸主动脉腔内修复术（TEVAR）。患者出院时身体状况良好，无任何并发症。
对于开胸手术风险极高的患者，应考虑采用 SEW 和 TEVAR 的杂交治疗策略治疗伴有主要脑灌注不良的 TAAAD。
