Department of Cardiac Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
J Cardiothorac Surg. 2023 Feb 10;18(1):72. doi: 10.1186/s13019-023-02154-z.
Acute aortic dissection type A (AADA) is associated with high perioperative morbidity and mortality. A novel non-covered hybrid prosthesis (AMDS, CryoLife, Kennesaw, USA) can be easily implanted to stabilize the true lumen. However, the role of AMDS for patients requiring additional aortic root surgery has not been described.
Between 2010 and 2020 a total of n = 370 patients underwent surgery for AADA in our department. Of those, n = 120 underwent treatment for aortic root in addition to proximal arch replacement without resection of the aorta beyond the innominate artery (Control, n = 111) and were compared to patients who received additional AMDS implantation (AMDS, n = 9).
Aortic valve repair was performed in 48.6% (Control) and in 55.6% of AMDS patients. Cardiopulmonary bypass (Control: 248 ± 76 min, AMDS: 313 ± 53 min, P < 0.01) time as well as circulatory arrest time of the lower body (Control: 30 ± 15 min, AMDS: 52 ± 12 min, P < 0.01) was prolonged in the AMDS group. Nevertheless, postoperative in-hospital morbidity such as dialysis (Control: 22.4%, AMDS: 11.1%, P = 0.68) and stroke (Control: 17.0%, AMDS: 22.2%, P = 0.65) were comparable. In-hospital death (Control: 21.8%, AMDS: 11.1%, P = 0.68) and the compound end-point MACCE (Control: 38.7%, AMDS: 44.4%, P = 0.74) did also not differ.
Addressing the arch by implantation of AMDS prolongs cardiopulmonary bypass and circulatory arrest time, however without relevant impairments of short-term outcome. Combining root surgery with replacement of the proximal aortic arch and AMDS implantation seems feasible and safe as it did not impair the early postoperative outcome.
急性主动脉夹层 A 型（AADA）与围手术期高发病率和高死亡率相关。一种新型非覆膜杂交假体（AMDS，CryoLife，美国肯尼索）可轻松植入以稳定真腔。然而，对于需要额外主动脉根部手术的患者，AMDS 的作用尚未描述。
2010 年至 2020 年，我们科室共有 370 例 AADA 患者接受手术治疗。其中，120 例患者在近端弓置换术的基础上进行了主动脉根部治疗，未切除无名动脉以上的主动脉（对照组，n=111），并与接受额外 AMDS 植入术的患者（AMDS 组，n=9）进行比较。
主动脉瓣修复在对照组（48.6%）和 AMDS 组（55.6%）中进行。AMDS 组体外循环（对照组：248±76 分钟，AMDS：313±53 分钟，P<0.01）和下半身停循环时间（对照组：30±15 分钟，AMDS：52±12 分钟，P<0.01）延长。然而，AMDS 组术后住院期间的发病率，如透析（对照组：22.4%，AMDS：11.1%，P=0.68）和中风（对照组：17.0%，AMDS：22.2%，P=0.65）相似。住院期间死亡率（对照组：21.8%，AMDS：11.1%，P=0.68）和复合终点 MACCE（对照组：38.7%，AMDS：44.4%，P=0.74）也无差异。
通过植入 AMDS 治疗弓部会延长体外循环和停循环时间，但不会对短期结果产生明显影响。将根部手术与近端主动脉弓置换术和 AMDS 植入术相结合是可行且安全的，因为它不会损害术后早期结果。
