Stanford A型主动脉夹层的外科治疗

目的 总结65例主动脉夹层的外科治疗经验,探讨治疗A型主动脉夹层的手术方式.方法 2003年9月～2010年4月共收治65例A型主动脉夹层患者.术中根据主动脉内膜破口的位置、夹层累及的范围、是否合并主动瓣关闭不全选择不同的手术方式,其中10例行单纯主动脉置换,13例行升主动脉+主动脉弓或半弓人工血管置换,27例行升主动...

Surgical treatment of Stanford type A aortic dissection

Objective    To review surgical treatment of type A aortic dissection in 65 patients and to investigate the effectiveness of surgical approaches. Methods    Between September, 2003 and April, 2010, 65 patients,  including 45 males and 20 females from 26 to 58 (mean 41.6 ± 9.5) years old, with Stanford type A aortic dissection underwent surgical treatment. Different surgical approaches were adopted according to the rupture site, extent of dissection and aortic valvular insufficiency, including ascending aorta replacement only (10 cases), ascending aorta replacement + arch or semi-arch replacement (13 cases), ascending aorta replacement + arch or semi-arch replacement with stented elephant trunk (27 cases), ascending aorta replacement + four branches covered stent graft implantation (7 cases) and Bentall operation only (8 cases). Concomitant procedures were coronary artery bypass grafting (4 cases), aortic valvuloplasty(12 cases), aortic valve replacement(8 cases ) or Bentall operation (6 cases). Deep hypothermic circulation arrest with selective cerebral perfusion was employed in cases of aortic arch replacement and/or  endovascular stent repair. Results    In the operations, the CPB, clamp and circulation arrest time were 86 -350 (188.3±60.9), 60-248 (101.1±40.0)  and 20-120 (53.9±24.3) minutes, respectively. There were two deaths  early  after operation. Onedied from low cardiac output syndrome  and the other died from renal failure. Postoperative intensive care stay was 1~63 (4.2±8.8) days and the hospital stay was 13~106 (24.8±13.8) days. Complications  consisted of motor aphasia(n=1), cerebral embolism(n=1), pulmonary infection(n=3), renal failure(n=1), hemorrhage(n=5), mental disorder(n=4), tracheotomy (n=1), and voice hoarseness(n=1). Conclusion     Aortic dissection is the most common catastrophic event that involves the aorta, however, the prospects of early surgical treatment are satisfying.  The key points are quick, correct diagnosis and proper surgical approaches.