左颈总动脉至左锁骨下动脉转流加支架象鼻术治疗复杂Stanford B型主动脉夹层

目的:总结左颈总动脉至左锁骨下动脉转流,加支架象鼻术治疗复杂Stanford B型主动脉夹层的临床经验及效果。方法:回顾性分析2009年1月至2011年12月,北京安贞医院5例男性复杂型Stanford B型主动脉夹层患者,行左颈总动脉至左锁骨下动脉转流加直视下支架象鼻手术。平均年龄(48.4±10.5)岁,合并高血压5例,急性夹层2例,慢性夹层3例,胸降主动脉覆膜支架置入术后Ⅰ型内漏2例。合并风湿性心脏病1例,合并糖尿病1例。结果:5例Stanford B型主动脉夹层患者均于全麻下行左颈总动脉至左锁骨下动脉转流加直视下支架象鼻术。同期手术包括1例主动脉瓣及二尖瓣机械瓣置换术。平均体外循环时间(151.8±29.2)min,心肌阻断时间平均(76.0±34.39)min,选择性脑灌注时间平均(21.2±8.0)min。住院时间平均(19.8±6.2)d,术后住院时间平均(9.0±2.7)d,ICU时间平均(1.4±0.5)d。5例患者均无截瘫、脑梗死,无围手术期死亡。术后复查夹层破口均封闭良好,未见残余漏。结论:左颈总动脉至左锁骨下动脉转流加直视下支架象鼻手术对复杂型Stanford B型夹层,是有效的外科治疗手段。近期效果满意,远期效果有待进一步观察。

Management of complicated stanford B aortic dissection using left common carotid-to-left subclavian arterial bypass with stented elephant trunk

Objective: To summarize the clinical experience and results of left common carotid to left subclavian arterial bypass with stented elephant trunk in the treatment of complicated Stanford B aortic dissection.Methods: Five patients with complicated Stanford B aortic dissection underwent left common carotid-to-left subclavian arterial bypass with stented elephant trunk from January 2009 to December 2011 in Beijing Anzhen Hospital.All patients were male with an average age of(48.4±10.5) years.There were 2 acute dissections and 3 chronic dissections,and type I endoleak after endovascular repair of thoracic descending aortic dissection in 2 cases.Comorbidities included hypertension in 5 cases,rheumatic heart disease in 1 and diabetes mellitus in 1.Results: All procedures were performed under general anesthesia.Additional operations included 1 case of aortic and mitral valve replacement with mechanical prosthesis.The mean cardiopulmonary bypass,aortic cross clamp and selective cerebral perfusion and lower body arrest times were(151.8 ± 29.2),(76.0 ± 34.3) and(21.2 ± 8.0) minutes,respectively.The lengths of ICU,postoperative and total hospital stay averaged(1.4 ± 0.5),(9.0 ± 2.7),and(19.8 ± 6.2) days.The postoperative hospital stay was(9.0±2.7) days.The mean ICU stay was(1.4±0.5) days,respectively.All patients survived the operation.There was no case of paraplegia and cerebral infarction.The tear of aortic dissection was closed well and no residual shunt was detected on computed tomography after the treatment.Conclusion: Left common carotid-to-left subclavian arterial bypass with stented elephant trunk procedure is an effective surgical treatment for patients with complicated Stanford B aortic dissection.The short-term results were satisfactory and further follow-up are warranted to determine its long-term results.