应用新型三分支主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层的临床研究

目的应用一种全新的三分支型主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层,并评价其安全性和疗效。方法 2009年12月～2010年6月,4例急性Stanford A型主动脉夹层患者接受新型三分支覆膜支架手术治疗。结果 4例手术全部成功,无死亡。手术时间（256.8±49.5）min,体外循环时间（137.2±24.6）min,心肌血运阻断时间（84.5±10.3）min,深低温停循环选择性脑灌注时间（18.7±7.9）min。患者术后及时清醒,循环稳定,无严重并发症发生。随访1～6个月,患者主动脉弓部及分支动脉内支架扩张贴壁满意,相应部位假腔消失,远端假腔内血栓填充;无与覆膜支架相关的并发症发生。结论采用三分支主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层,简化了主动脉弓部操作,降低了手术风险,适合于大多数Stanford A型主动脉夹层患者的治疗,近期效果满意,其长期效果尚需大宗病例进一步观察。

The clinical study on open placement of new triple-branched aortic arch covered stent graft for acute Stanford type A aortic dissection

Objective To evaluate the surgical safety and effect of open placement of new triple-branched aortic arch covered stent graft for acute Stanford type A aortic dissection.Methods Total 4 patients of acute Stanford type A aortic dissection were undergone operation with placement of new triple-branched aortic arch covered stent graft from December 2009 to June 2010.Results 4 cases of operation were successfully performed,no death happened.The average operation time was （256.8±49.5）minutes,the cardiopulmonary bypass time was （137.2±24.6）minutes,the clamp time was （84.5±10.3）minutes,and the deep hyperthermic circulatory arrest and antegrade selective cerebral perfusion was （18.7±7.9）minutes.All patients revived timely after operation,the circulation was stable and no serious neurological complications occured.During following-up period of 1 to 6 months,triple-branched aortic arch covered stent graft expanded well,the corresponding false lumen of the stent graft disappeared and the distal false lumen was filled with thrombus by aortic artery CT angiography.No complication related with stent graft was found.Conclusion The placement of new triple-branched aortic arch covered stent graft for acute Stanford type A aortic dissection simplifies the aortic arch procedure,and decreases the operative risk.It fits to most patients with Stanford type A aortic dissection.The short-term effect is good,but its long-term results need advanced observation.