支架象鼻置入联合左锁骨下动脉-左颈总动脉转流术治疗急性Stanford B型主动脉夹层累及远端主动脉弓的临床经验

Repair of acute Stanford type B dissection with distal aortic arch involvement using stented elephant trunk implantation combined with left subclavian artery-left common carotid artery transposition

目的总结支架象鼻置入联合左锁骨下动脉(LSCA)-左颈总动脉(LCCA)转流术治疗急性Stanford B型主动脉夹层累及远端主动脉弓的临床经验。方法回顾性分析2011年4月至2015年4月在首都医科大学附属北京安贞医院心脏外科接受支架象鼻置入联合LSCA-LCCA转流术治疗的27例急性Stanford B型主动脉夹层累及远端主动脉弓患者的病历资料。结果本组患者中无手术死亡。平均体外循环时间(129±31)min(85~193 min),平均心肌阻断时间(58±33)min(24~147 min),选择性脑灌注时间(25±6)min(14~41 min)。25例患者呼吸机辅助时间≤24 1h。平均随访时间(32±12)个月(18~66个月)。同期手术包括主动脉瓣替换术+冠状动脉旁路移植术1例,冠状动脉旁路移植术1例,左椎动脉起源于主动脉弓-LCCA转流术3例。随访期间1例患者死亡,1例患者行胸腹主动脉替换术,痊愈出院。CT结果显示支架象鼻远端假腔闭合率为88.9%(24/27)。结论应用支架象鼻置入联合LSCA-LCCA转流术治疗急性Stanford B型主动脉夹层累及远端主动脉弓效果满意。

Objective To summarize the experience of stented elephant trunk implantation combined with left subclavian artery＇（ LSCA）-left common carotid artery （LCCA） transposition treating acute Stanford type B dissection with distal aortic arch involvement. Methods A retrospective study was performed in 27 patients with acute Stanford type B dissection with distal aortic arch involvement who had elephant trunk implantation combined with LSCA-LCCA transposition from April 2011 to April 2015 in Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University. Basic clinical data and surgical date＇ were analyzed. Results There was no in-hospital death. Mean cardiopulmonary bypass time was （129 ± 31 ）min（85-193 min） ; mean aortic cross-clamp time was （ 58 ± 33 ） min （ 2±147 min ） ; mean selective antegrade cerebral perfusion time was （ 25 ± 6 ） min （1±41 min）. Mechanical ventilation time was ≤24 h in 25 patients. Mean follow-up time was （32 ± 12）months （18-66 months）. Concomitant procedures included aortic valve replacement ＋ coronary artery bypass graft in 1 patient, coronary artery bypass graft in 1 patient and isolated left vertebral artery-LCCA transposition in 3 patients. There was 1 death during follow-up; 1 patient had thoracoabdominal aortic replacement and recovered well. CT showed that the distal stent-graft false lumen closure rate was 88. 9% （ 24/27 ）. Conclusion Stented elephant trunk implantation with LSCA-LCCA transposition has a good curative effect on acute Stanford type B dissection with distal aortic arch involvement.