Hu Zhipeng, Wang Zhiwei, Chang Jinxing, Zhang Min, Hu Xiaoping, Ren Zongli, Li Bowen, Hu Rui
Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
J Thorac Dis. 2021 Feb;13(2):533-540. doi: 10.21037/jtd-20-2578.
The advantages of prosthesis eversion method in patients diagnosed with Stanford type A acute aortic dissection (AAD) undergoing ascending aorta replacement (AAR) is unknown. This research is designed to explore it.
We retrospectively analyzed the data of a total of 283 patients diagnosed with type A aortic dissection that underwent surgery in Renmin Hospital of Wuhan University from March, 2006 to April, 2020. Eighty-eight patients underwent surgical repair with traditional continuous suture technique, and 195 patients received prosthesis eversion. Baseline data, intra-operative data and early-stage clinical results were collected and statistically analyzed.
Baseline data were similar except for age, incidence of hyperlipidemia and taking ACEI/ARB drugs (P<0.05). Cardiopulmonary bypass time, cross-clamp time, circulation arrest time, hemostasis time and total operation time in the traditional method group were far longer than in the prothesis eversion group (P<0.01). The operative mortality was similar (P>0.01). Post-operatively, there was no statistically significant difference in the mean ventilation time, mortality, incidence of re-exploration, tracheostomy, paraplegia, long-term coma and stroke between the two groups (P>0.05). Patients in the traditional method group had a longer duration stay in ICU and hospital than patients in the prosthesis eversion group (P<0.05). Patients in the traditional method group received more red blood cells (RBC) (P<0.01), plasma (P<0.05), fibrinogen (P<0.01) and albumin (P<0.05) transfusions, and CoSeal™ surgical sealant (P<0.05) than patients in the prosthesis eversion group.
Our experience and statistical analysis showed prosthesis eversion method to have some advantage in reducing blood loss and improving clinical results compared with repair with continuous suture. This technique is both simple to learn and perform.
对于诊断为 Stanford A 型急性主动脉夹层（AAD）并接受升主动脉置换术（AAR）的患者，人工血管外翻法的优势尚不清楚。本研究旨在对此进行探索。
我们回顾性分析了2006年3月至2020年4月在武汉大学人民医院接受手术的283例诊断为 A 型主动脉夹层患者的数据。88例患者采用传统连续缝合技术进行手术修复，195例患者接受人工血管外翻术。收集基线数据、术中数据和早期临床结果并进行统计分析。
除年龄、高脂血症发病率和服用 ACEI/ARB 药物情况外，基线数据相似（P<0.05）。传统方法组的体外循环时间、主动脉阻断时间、循环停止时间、止血时间和总手术时间均远长于人工血管外翻组（P<0.01）。手术死亡率相似（P>0.01）。术后，两组之间的平均通气时间、死亡率、再次手术发生率、气管切开术、截瘫、长期昏迷和中风发生率无统计学显著差异（P>0.05）。传统方法组患者在重症监护病房（ICU）和医院的住院时间长于人工血管外翻组患者（P<0.05）。传统方法组患者比人工血管外翻组患者接受更多的红细胞（RBC）输注（P<0.01）、血浆输注（P<0.05）、纤维蛋白原输注（P<0.01）和白蛋白输注（P<0.05），以及 CoSeal™手术密封剂（P<0.05）。
我们的经验和统计分析表明，与连续缝合修复相比，人工血管外翻法在减少失血和改善临床结果方面具有一定优势。该技术易于学习和操作。
