分支介入优先的杂交手术治疗急性Standford A型主动脉夹层合并重要器官灌注不良疗效分析研究

Effect analysis of interventional radiological"branch first"hybrid surgery in the treatment of Stanford type A aortic dissection with malperfusion syndrome

目的评估分支介入优先的杂交手术技术治疗急性Standford A型夹层(ATAAD)合并重要器官灌注不良的临床疗效。方法连续收集2018年11月至2020年11月空军军医大学第一附属医院心血管外科采用分支介入优先的策略治疗ATAAD合并重要器官灌注不良的43例患者围术期相关数据并进行回顾性分析。43例患者均经过术前检查和综合评估,因合并重要器官灌注不良不具备急诊行开放主动脉修复手术,因此考虑分支介入优先策略,急诊通过介入技术恢复分支血管血运,改善主要脏器缺血后再联合开放主动脉修复手术。结果所有纳入患者分支介入优先治疗后,其中由于重要器官功能衰竭未能行开放手术11例,器官功能恢复期间出现主动脉夹层破裂死亡未能行开放手术6例。介入手术后接受开放手术治疗的26例,其中22例器官功能恢复良好无重要器官功能不全严重并发症,痊愈出院,无严重器官功能障碍。联合手术后因器官功能不全严重并发症死亡4例。结论通过分支优先的介入治疗策略先恢复重要器官的灌注和功能,对于合并严重器官灌注不良不具备急诊开放主动脉修复手术条件的ATAAD患者,能获得开放手术的机会,降低开放手术后围术期死亡率和严重并发症发生率。

Objective To evaluate the efficacy of interventional radiological"branch first"hybrid surgery in the treatment of acute Standford type A aortic dissection(ATAAD)with malperfusion syndrome.Methods The perioperative data of 43 ATAAD patients with malperfusion syndrome treated with interventional radiological"branch first"strategy at the Department of Cardiovascular Surgery of the First Affiliated Hospital of Air Force Medical University were consecutively collected and analyzed.All included patients underwent preoperative examination and comprehensive evaluation.Due to malperfusion of major organs,they were not eligible for emergency open surgerical aortic repair.Therefore,through the"branch first"strategy,emergency interventional radiology was performed to restore blood flow in the branch and improve the malperfusion syndrome in major organs and then open aortic repair was scheduled.Results Among all the 43 ATAAD patients with malperfusion syndrome were treated with interventional radiological"branch first"strategy,after endovascular reperfusion,11 patients failed to undergo open aortic repair due to failure of major organs and 6 patients died from aortic dissection rupture during the recovery of organ function.Among the 26 patients who underwent open aortic repair after interventional radiology,22 patients recovered well without severe complications of major organ dysfunction and were discharged.Four patients died of severe complications of dysfunction after combined operation.Conclusion By restoring perfusion and function of major organs through interventional radiological"branch first"strategy,ATAAD patients with severe malperfusion syndrome who are not eligible for emergency open aortic repair,the opportunity of open surgery can be obtained,and the perioperative mortality and the incidence of severe complications after the open surgery can be reduced.