分期杂交全弓置换在急性Stanford A型主动脉夹层的围术期及早期随访结果

Perioperative and early follow-up results of staging hybrid total arch replacement for acute Stanford A aortic dissection

目的分析分期杂交全弓置换在急性Stanford A型主动脉夹层的围术期及早期随访结果。方法31例急性Stanford A型主动脉夹层患者,均行分期杂交全弓置换手术。观察患者开放手术术中及术后情况,胸主动脉支架植入术后情况。结果31例患者中,无住院死亡患者,体外循环时间(201.0±36.2)min,阻断时间(112.0±24.6)min,1例(3.2%)患者深低温停循环6 min。17例(54.8%)患者术前主动脉瓣重度返流,遂行带主动脉瓣人工血管升主动脉替换术(Bentall)+头臂血管去分支;3例(9.7%)患者仅行升主动脉置换+降主动脉腔内支架植入术;其余11例(35.5%)患者行主动脉窦成形+升主动脉置换+头臂血管去分支,其中1例患者未重建左锁骨动脉。1例(3.2%)患者术后发生截瘫,2例(6.5%)患者肾功能不全,无需要透析病例。2例(6.5%)患者急诊行主动脉造影+胸主动脉支架植入术。支架远端假腔血栓化率为90.3%,无内漏等支架相关并发症。结论分期杂交全弓置换手术是急性Stanford A型主动脉夹层的一种安全、可靠的治疗方法,且可以避免深低温停循环和体外循环时间过长所带来的风险。

Objective To analyze the perioperative and early follow-up results of staged hybrid total arch replacement for acute Stanford A aortic dissection.Methods 31 acute Stanford type A aortic dissection patients underwent staged hybrid total arch replacement.The conditions of patients during and after open surgery,and the condition of patients after thoracic aortic stent implantation were observed.Results Among the 31 patients,no cases died in hospital,the extracorporeal circulation time was(201.0±36.2)min,the blocking time was(112.0±24.6)min,and 1 patient(3.2%)had deep hypothermic circulatory arrest for 6 min.17 patients(54.8%)had severe regurgitation of the aortic valve before operation,and then performed Bentall operation and debranching of the brachiocephalic vessel.3 patients(9.7%)only received ascending aortic replacement and descending aortic stent implantation.The remaining 11 patients(35.5%)underwent aortic sinus angioplasty,ascending aortic replacement and brachiocephalic vessel debranching,and 1 patient did not rebuild the left clavicle artery.1 patient(3.2%)had paraplegia after operation,and 2 patients(6.5%)had renal insufficiency and no patients need dialysis.1 patient(3.2%)had transient consciousness disturbance,and 2 patients(6.5%)underwent emergency aortic angiography and thoracic aortic stent implantation.The thrombosis rate of the false cavity in the distal end of the stent was 90.3%,and there were no stent-related complications such as endoleak.Conclusion Staged hybrid total arch replacement is a safe and reliable method for acute Stanford A aortic dissection,which can avoid the risk of deep hypothermic circulatory arrest and prolonged extracorporeal circulation time.