术中置入新型三分支主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层临床研究

Open placement of new triple-branched aortic arch covered stent graft for acute Stanford type A aortic dissection

目的应用新型三分支型主动脉弓覆膜支架治疗急性Stanford A型主动脉夹层,总结其临床应用经验,并评价其安全性和疗效。方法 2009年12月至2011年1月7例急性Stanford A型主动脉夹层患者在我科接受新型三分支主动脉弓覆膜支架手术治疗。结果全组手术时间(259.2±53.6)分钟,体外循环时间(136.4±28.5)分钟,心肌血运阻断时间(85.3±11.7)分钟,深低温停循环选择性脑灌注时间(17.6±8.2)分钟。术中死亡1例,系术中主动脉开放后主动脉根部后壁大出血无法止血;其余6例患者术后及时清醒,循环稳定,无严重并发症发生。随访2～15个月,主动脉血管成像显示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;患者心功能改善,生活质量良好。结论 采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,可以简化主动脉弓部操作,降低手术风险,提高手术成功率,适合于大多数Stanford A型主动脉夹层患者的治疗。

Objective To summarize the experience of open placement of new triple-branched aortic arch covered stent graft for acute Stanford type A aortic dissection,and evaluate the safety and effect of surgery.Methods A total of 7 cases of acute Stanford type A aortic dissection underwent placement of new triple-branched aortic arch covered stent graft from December 2009 to January 2011.Results The average operation time was（259.2±53.6）minutes.The cardiopulmonary bypass time was（136.4±28.5）minutes.The clamp time was（85.3±11.7）minutes.And the deep hypothermic circulatory arrest and antegrade selective cerebral perfusion time was（17.6±8.2）minutes.One patient died of aortic root bleeding.Other 6 patients revived timely after operation.The circulation was stable and no serious complications occurred.During following-up period of 2 to 15 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.The heart function of 6 patients was improved,and the life quality was good.Conclusions The open placement of new triple-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.It fits to most patients with Stanford type A aortic dissection.