Wang Weitie, Wang Yong, Piao Hulin, Zhu Zhicheng, Li Dan, Wang Tiance, Liu Kexiang
Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China.
Front Cardiovasc Med. 2022 Sep 7;9:944612. doi: 10.3389/fcvm.2022.944612. eCollection 2022.
This study aimed to report our results of ministernotomy approach to Liu's aortic root repair technique, Liu's aortic arch inclusion technique with frozen elephant trunk (FET) in the treatment in type A aortic dissection (TAAD). We retrospectively analyzed data on 68 Stanford A aortic dissection patients from October 2017 to March 2020. All patients underwent Liu's aortic root repair technique, Liu's aortic arch inclusion technique with FET and mild-moderate hypothermic circulatory arrest combined with ministernotomy approach. 154 TAAD patients between January 2014 and December 2016 underwent complete sternotomy were selected as control group. Clinical characteristics, data during operation, in-hospital and postoperative outcomes of these patients were observed. The mean hypothermic circulatory arrest time in ministernotomy Patients was 39.3 ± 7.9 min, aortic cross-clamp time was 105.9 ± 12.8 min, cardiopulmonary bypass time was 152.8 ± 24.3 min. Three patients died of multiple organ dysfunction syndrome in ministernotomy Patients. Perioperative temporary neurological dysfunction occurred in three (4.41%) patients, and 53 (77.9%) patients did not require any blood product transfusion during and after operation in ministernotomy Patients. Postoperative CT angiography (CTA) examination at 6-32 months showed excellent outcomes except in three (4.41%) cases where arch false lumen patency persisted. The Liu's aortic root repair technique, Liu's aortic arch inclusion technique with FET and mild-moderate hypothermia circulatory arrest simplify the surgical procedure and reduce bleeding, which can be accomplished through minimally invasive approach.
本研究旨在报告我们采用胸骨上段小切口入路行刘氏主动脉根部修复技术、刘氏带冰冻象鼻支架（FET）的主动脉弓部置入技术治疗A型主动脉夹层（TAAD）的结果。我们回顾性分析了2017年10月至2020年3月期间68例斯坦福A型主动脉夹层患者的数据。所有患者均接受刘氏主动脉根部修复技术、刘氏带FET的主动脉弓部置入技术以及浅-中度低温循环阻断并联合胸骨上段小切口入路。选取2014年1月至2016年12月期间接受正中胸骨切开术的154例TAAD患者作为对照组。观察这些患者的临床特征、手术中的数据、住院期间及术后的结果。胸骨上段小切口入路患者的平均低温循环阻断时间为39.3±7.9分钟，主动脉阻断时间为105.9±12.8分钟，体外循环时间为152.8±24.3分钟。胸骨上段小切口入路患者中有3例死于多器官功能障碍综合征。围手术期有3例（4.41%）患者发生短暂性神经功能障碍，胸骨上段小切口入路患者中有53例（77.9%）患者在手术中和术后无需输注任何血液制品。术后6至32个月的CT血管造影（CTA）检查显示，除3例（4.41%）患者的主动脉弓假腔持续通畅外，其余结果均良好。刘氏主动脉根部修复技术、刘氏带FET的主动脉弓部置入技术以及浅-中度低温循环阻断简化了手术操作并减少了出血，可通过微创入路完成。
