应用分支型主动脉弓覆膜支架重建弓部治疗急性Stanford A型主动脉夹层

目的总结术中置入分支型主动脉弓覆膜支架重建弓部治疗急性Stanford A型主动脉夹层的临床应用经验,并评价其安全性和疗效。方法对2009年12月～2012年3月接受分支型主动脉弓覆膜支架置入治疗的17例急性Stanford A型主动脉夹层患者的临床资料进行回顾性分析。结果术中置入三分支型主动脉弓覆膜支架16例,一分支型主动脉弓覆膜支架1例。全组手术时间(276±54)min,体外循环时间(141±28)min,心肌血运阻断时间(81±12)min,深低温停循环选择性脑灌注时间(17±7)min。术中死亡1例,术后死亡3例,其余患者痊愈出院,术后住院时间(14±6)d。13例随访5～32个月,主动脉血管成像(CTA)显示患者主动脉弓降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。结论术中置入分支型主动脉弓覆膜支架重建弓部治疗急性Stanford A型主动脉夹层,可以简化主动脉弓部操作,降低手术风险,提高手术成功率。

The application of open placement of branched aortic arch covered stent graft for acute Stanford type A aortic dissection

Objective To summarize the experience of open placement of branched aortic arch covered for acute Stanford type A aortic dissection, and to evaluate the surgical safety and effect. Methods Total 17 stent graft patients of acute Stanford type A aortic dissection under went operation with placement of branched aortic arch covered stent graft from December 2009 to March 2012. Results Triple-branched aortic arch covered stent graft was used for 16 patients and one-branched aortic arch covered stent graft was used for 1 patient. The average operation time was （276±54） mi- nutes, the cardiopulmonary bypass time was （141±28） minutes, the clamp time was （81 ±12） minutes, and the deep hyperthermic circulatory arrest and antegrade selective cerebral perfusion time was （17±7） minutes. 1 patient died of in- tropeative bleeding and 3 patients died of postoperative complications, other patients were cured and discharged. The postoperative hospital stay was （14±6） days. During following-up period of 5 to 32 months, branched aortic arch cov- ered 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 in 13 patients. No complication related with stent graft was found. Conclusion The open placement of branched aortic arch covered stent graft for acute Stanford type A aortic dissection can simplify the aortic arch procedure, decrease the operation risk, and increase the operation success rate.