Ando M, Nakajima N, Adachi S, Nakaya M, Kawashima Y
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Ann Thorac Surg. 1994 Mar;57(3):669-76. doi: 10.1016/0003-4975(94)90565-7.
We performed simultaneous graft replacement of the total aortic arch and ascending aorta for type A aortic dissection with a patent false lumen extending through the arch into the descending or abdominal aorta. During the past 7 years, this procedure was performed in 42 patients (28 men and 14 women), aged 20 to 72 years (mean age, 50 years). Nineteen patients underwent the procedure during the acute period, and 23 during the chronic period. The site of the initial intimal tear was the ascending aorta in 17 patients and the transverse aortic arch in 25 patients. Artificial graft replacement was initially accomplished by proximal anastomosis, followed by open distal anastomosis, and finally by anastomosis of each of the three arch vessels. There were 3 hospital deaths (7.1%), 1 resulting from acute dissection (5.3%) and 2 from chronic dissection (8.7%). Among the type A dissections, total arch graft replacement has been indicated in the setting of rupture of the aortic arch, arch dissection, and Marfan's syndrome. However, with increasing experience in arch reconstructions and improvement in outcome, the indications could be expanded to include all type A aortic dissections with a patent false lumen in the descending aorta.
我们对主动脉弓和升主动脉均有夹层且存在自主动脉弓延伸至降主动脉或腹主动脉的通畅假腔的A型主动脉夹层患者进行了同期移植物置换术。在过去7年中，42例患者（28例男性和14例女性）接受了该手术，年龄在20至72岁之间（平均年龄50岁）。19例患者在急性期接受手术，23例在慢性期接受手术。初始内膜撕裂部位在升主动脉的有17例患者，在主动脉弓横部的有25例患者。人工移植物置换术最初通过近端吻合完成，随后进行开放远端吻合，最后进行三根弓血管的逐一吻合。有3例患者术后死亡（7.1%），1例死于急性夹层（5.3%），2例死于慢性夹层（8.7%）。在A型夹层中，全弓移植物置换术适用于主动脉弓破裂、弓部夹层和马凡综合征。然而，随着弓部重建经验的增加和预后的改善，适应证可扩大至包括所有降主动脉存在通畅假腔的A型主动脉夹层。
