Surgical Treatment for Patients with Stanford Type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAOYi-min ,  XIAOMing-di , WANGLian-cai , CHENGChang

Department of Cardiovascular Surgery, Shanghai Yuanda Heart Hospital, Shanghai 200315, P. R. China;

Corresponding?author：

XIAOMing-di, Email: xymshow@hotmail.com

Keywords：

Stanford type A aortic dissection; Surgery; Mortality; Complication

DOI：

10.7507/1007-4848.20140099

Video：

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Objective To summarize our clinical experience of surgical treatment for 51 patients with Stanford type A aortic dissection (AD). Methods Clinical data of 51 patients with Stanford type A AD who received surgical treatment in Shanghai Yuanda Heart Hospital between February 2009 and January 2013 were retrospectively analyzed. There were 29 males and 22 females with their age of 35-63 (47.2±11.1)years. The diagnosis of all the patients was confirmed by enhanced CT scan and Doppler echocardiography. Surgical procedures included Bentall procedure and Sun's procedure in 29 patients, Bentall procedure, mitral valve replacement and Sun's procedure in 2 patients, ascending aorta replacement and Sun's procedure in 17 patients, valsalva sinus plasty, ascending aorta replacement and Sun's procedure in 2 patients, ascending aorta replacement (stage 1), Sun's procedure (stage 2)and endovascular exclusion of the thoracic aorta (stage 3)in 1 patient. Results Mean operation time was 320.6±77.3 minutes, cardiopulmonary bypass time was 190.4±63.4 minutes, aortic cross-clamp time was 123.2±45.1 minutes, duration of circulatory arrest with hypothermia was 28.2±11.1 minutes, and mean length of hospital stay was 13.4±4.2 days. Two patients (3.9%)died perioperatively including 1 patient with intraoperative bleeding and another patient with delayed bleeding after operation. Postoperative complications included bleeding, paraplegia, perivalvular leak and sternal dehiscence in 1 patient respectively, and endoleak in 2 patients. Forty-nine patients were followed up for 3-48 (25.3±10.5)months and no late death occurred. Conclusion Surgical treatment is effective for patients with Stanford type A AD.

Citation： XIAOYi-min, XIAOMing-di, WANGLian-cai, CHENGChang. Surgical Treatment for Patients with Stanford Type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 361-363. doi: 10.7507/1007-4848.20140099 Copy

1.	孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):49-55.
2.	Perreas K, Samanidis G, Dimitriou S, et al. Outcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circula-tory arrest with retrograde cerebral perfusion:analysis of 207 patients. Interact Cardiovasc Thorac Surg, 2012, 15 (3):456-461.
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4.	孫立忠, 劉志剛, 常謙, 等.主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層.中華外科雜志, 2004, 42 (13):812-816.
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6.	Ryckwaer F, Colson P, Ribstein J, et al. Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfuntion. Br J Anaesth, 2001, 86 (2):169-175.
7.	Elalamy I, Lecrubier C, Horellou MH, et al. Heparin-induced thrombocytopenia:laboratory diagnosis and management. Ann Med, 2000, 32 (Suppl 1):60-67.
8.	Lubenow N, Greinacher A. Management of patient with pathobiology of heparin-induced thrombocytopenia:focus on recombinant hirudin. J Thromb Thrombolysis, 2000, 10:S47-S57.
9.	Kr?henbühl ES, Immer FF, Stalder M, et al. Temporary neurological dysfuction after surgery of the thoracic aorta:a predictor of poor outcome and impaired quality of life. Eur J Cardiothorac Surg, 2008, 33 (6):1025-1029.
10.	Pacini D, Di Marco I, Leone A, et al. Cerebral functions and metab-olism after antegrade selective cerebral perfusion in aortic arch surgery. Eur J Cardiothorac Surg, 2010, 37 (6):1322-1331.
11.	尚蔚, 劉楠, 閆曉蕾, 等. A型主動脈夾層手術后早期并發癥分析.心肺血管病雜志, 2011, 30 (3):183-186.
12.	Szeto WY, Desai ND, Moeller P, et al. Reintervention for endograft failures after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg, 2013, 145 (3 Suppl):S165-S170.
13.	黃連軍, 孫立忠, 朱俊民, 等.覆膜血管內支架種植治療B型主動脈夾層.醫學研究雜志, 2006, 35 (1):18-20.
14.	馬黎明, 褚衍林, 喬衍禮, 等.急診心臟瓣膜替換25例報告.心肺血管病雜志, 2010, 29 (1):15-18.
15.	張寶仁, 徐志云, 鄒良建, 等.人工心臟瓣膜置換術后63例瓣周漏的外科治療.中國胸心血管外科臨床雜志, 2007, 14 (2):81-84.

1. 孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43 (18):49-55.
2. Perreas K, Samanidis G, Dimitriou S, et al. Outcomes after ascending aorta and proximal aortic arch repair using deep hypothermic circula-tory arrest with retrograde cerebral perfusion:analysis of 207 patients. Interact Cardiovasc Thorac Surg, 2012, 15 (3):456-461.
3. 張力, 王平凡, 梁志強, 等. 201例Stanford A型主動脈夾層的外科治療.中國綜合臨床, 2012, 28 (4):418-421.
4. 孫立忠, 劉志剛, 常謙, 等.主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層.中華外科雜志, 2004, 42 (13):812-816.
5. Minami T, Imoto K, Uchida K, et al. Clinical outcomes of emergency surgery for acute type B aortic dissection with rupture. Eur J Cardiothorac Surg, 2013, 44 (2):360-364.
6. Ryckwaer F, Colson P, Ribstein J, et al. Haemodynamic and renal effects of intravenous enalaprilat during coronary artery bypass graft surgery in patients with ischaemic heart dysfuntion. Br J Anaesth, 2001, 86 (2):169-175.
7. Elalamy I, Lecrubier C, Horellou MH, et al. Heparin-induced thrombocytopenia:laboratory diagnosis and management. Ann Med, 2000, 32 (Suppl 1):60-67.
8. Lubenow N, Greinacher A. Management of patient with pathobiology of heparin-induced thrombocytopenia:focus on recombinant hirudin. J Thromb Thrombolysis, 2000, 10:S47-S57.
9. Kr?henbühl ES, Immer FF, Stalder M, et al. Temporary neurological dysfuction after surgery of the thoracic aorta:a predictor of poor outcome and impaired quality of life. Eur J Cardiothorac Surg, 2008, 33 (6):1025-1029.
10. Pacini D, Di Marco I, Leone A, et al. Cerebral functions and metab-olism after antegrade selective cerebral perfusion in aortic arch surgery. Eur J Cardiothorac Surg, 2010, 37 (6):1322-1331.
11. 尚蔚, 劉楠, 閆曉蕾, 等. A型主動脈夾層手術后早期并發癥分析.心肺血管病雜志, 2011, 30 (3):183-186.
12. Szeto WY, Desai ND, Moeller P, et al. Reintervention for endograft failures after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg, 2013, 145 (3 Suppl):S165-S170.
13. 黃連軍, 孫立忠, 朱俊民, 等.覆膜血管內支架種植治療B型主動脈夾層.醫學研究雜志, 2006, 35 (1):18-20.
14. 馬黎明, 褚衍林, 喬衍禮, 等.急診心臟瓣膜替換25例報告.心肺血管病雜志, 2010, 29 (1):15-18.
15. 張寶仁, 徐志云, 鄒良建, 等.人工心臟瓣膜置換術后63例瓣周漏的外科治療.中國胸心血管外科臨床雜志, 2007, 14 (2):81-84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Patients with Stanford Type A Aortic Dissection

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