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Survival rates were not significantly different between propensity-matched patients with type A aortic dissection who received a mechanical valve versus a nonmechanical valve.
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Objective: Early and mid-term result of transapical aortic (TAA) cannulation technique was evaluated compared with femoral artery (FA) cannulation in Acute Type A Aortic Dissection(AAAD).Methods: From January 2000 to October 2013, 80 consecutive patients with AAAD were underwent the ascending aortic replacement at Nagasaki Kouseikai Hospital. These patients were divided into two groups according to the cannulation site, FA cannulation (n = 34) and TAA cannulation (n = 46). Early and mid-term outcomes were compared between two groups.Result: Preoperative patient characteristics were almost comparable between groups. The time from skin incision to starting cardiopulmonary bypass (CPB) was significantly shorter in the TAA group (45 ± 16 vs 23 ± 5.1 min; P <0.001). There were no significant differences in post-operative cerebral infarction in two groups (17% versus 11%; P = NS). The operative mortality rate was 8.8% in FA group and 4.3% in TAA group (P = NS). During follow up (mean, 6.8 years), survival at 3 years and 5 years was 77.4% and 71.9% in TAA group and 76.3% and 73.8% in FA group, respectively.Conclusion: The postoperative morbidity and mortality between the two groups were almost the same. TAA cannulation for acute Type A aortic dissection is faster, easy and safe with acceptable early and mid-term outcome.  相似文献   

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Abstract   Acute Stanford type A aortic dissection is a fatal event that, for its high mortality when left untreated, requires urgent surgical intervention. The established treatment includes repair of the ascending aorta and various portions of the aortic arch, leaving the descending aorta untreated. We report the case of a 62-year-old man in whom a combined approach of the ascending aorta with surgical correction and transluminal placement of a stent in the aortic arch was performed.  相似文献   

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目的 总结Stanford A型主动脉夹层的治疗经验,评价其外科手术疗效。 方法 回顾性分析2006年10月至2013年3月兰州军区兰州总医院48例Stanford A型主动脉夹层行外科手术治疗的临床资料,其中男41例,女7例;年龄26~72 (47.6±9.2) 岁。急性Stanford A型主动脉夹层(发病至确诊<14 d) 43例,慢性5例。主动脉瓣中重度关闭不全19例+主动脉瓣良好、但合并马方综合征6例,行Bentall+全弓置换+支架象鼻术;累及主动脉根部、但瓣膜功能良好的8例行改良David+全弓置换+支架象鼻术;累及升主动脉10例行升主动脉+全弓置换+支架象鼻术;累及部分主动脉弓5例行升主动脉+次全弓置换术。出院后于术后3、6、12个月随访,以后每年随访1次。随访内容包括:患者的生存情况、血压控制情况、有无疼痛复发、运动、活动情况和复查主动脉计算机断层扫描成像(computerized tomography arteriography,CTA)。 结果 全组体外循环时间121~500 (191.4±50.6) min,主动脉阻断时间58~212 (112.3±31.7) min;停循环+选择性脑灌注时间26~56 (34.8±8.7) min;术后呼吸机辅助时间32~250 (76.2±35.6) h;住ICU时间3~20 (7.1±3.4) d。术后24 h胸腔引流量680~1 600 (1 092.5±236.3) ml。围术期死亡7例,病死率14.5%,其中死于多器官功能衰竭2例、低心排血量综合征2例、肾功能衰竭1例、迟发性难治性出血1例、昏迷1例。围术期发生其它并发症20例,经治疗均痊愈或好转出院。随访38例,随访率92.7%(38/41),随访时间3~48 (13.0±8.9) 个月;失访3例。随访期间36例存活,无与主动脉夹层相关的死亡,因其它慢性疾病死亡2例。无因主动脉夹层继续形成、假腔扩张行二次手术患者,术后6个月CTA检查未见吻合口渗漏及人工血管扭曲或血流不畅。 结论 根据主动脉夹层破口的位置、升主动脉直径及夹层累及范围等,选择合适的手术方式、手术时机及脏器保护策略是提高Stanford A型主动脉夹层治疗效果的关键。应用腋、股动脉联合灌注及提高术中最低温度等策略治疗Stanford A型主动脉夹层可获得良好的效果。  相似文献   

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