HybridⅡ全主动脉弓修复术治疗Stanford A型主动脉夹层的疗效分析

Efficacy analysis of typeⅡhybrid total aortic arch repair in the treatment of Stanford type A aortic dissection

目的:探讨HybridⅡ型主动脉弓修复术治疗Stanford A型主动脉夹层的疗效。方法:回顾性分析2020年10月至2021年12月应用HybridⅡ型主动脉弓修复技术治疗41例Stanford A型主动脉夹层患者的临床资料,其中男性29例,女性12例,年龄29~79岁,平均(54.51±11.66)岁,发病时间2~96 h。其中合并主动脉瓣关闭不全17例、夹层累及冠状动脉2例、脏器灌注不良5例、下肢供血障碍1例、高血压病36例、糖尿病4例、马方综合征2例。对围术期及随访结果进行分析。结果:手术成功率为100%,行升主动脉置换+主动脉弓去分支(Debranch)+主动脉支架置入术(TEVAR)16例,Bentall+Debranch+TEVAR 5例,窦部成形+升主置换+Debranch+TEVAR 20例。全组无单瘫、截瘫、昏迷等持续性神经功能障碍。术后意识模糊1例、躁动4例、谵妄2例。低氧血症15例、气管切开4例、肾功能衰竭行连续肾脏替代治疗5例。全组无延迟关胸、二次开胸止血及乳糜胸发生。随访6~12月,死亡2例,其中脑出血1例、重症感染1例(肺炎克雷伯杆菌)。结论:HybridⅡ型主动脉弓修复技术治疗Stanford A型主动脉夹层,避免深低温停循环,缩短了手术及体外循环时间,明显降低了围术期并发症发生率及死亡率,近期效果良好。

Objective:To investigate the efficacy of typeⅡhybrid total aortic arch repair in the treatment of Stanford type A aortic dissection.Methods:A retrospective study was performed on the clinical data of 41 Stanford type A aortic dissection patients,including 29 males and 12 females,who were treated by typeⅡhybrid total aortic arch repair technique from October 2020 to December 2021.The age ranged from 29 to 79 years,with an average age of(54.51±11.66)years,and the onset time ranged from 2 to 96 hours.There were 17 cases of aortic insufficiency,2 cases of coronary artery involvement by dissection,5 cases of organ malperfusion,1 case of lower limb blood supply disorder,36 cases of hypertension,4 cases of diabetes,and 2 cases of Marfan syndrome.The perioperative and follow‐up results were analyzed.Results:The overall surgical success rate was 100%(41/41).For the details of surgery,16 cases underwent ascending aorta replacement+Debranch+TEVAR procedure,5 cases underwent Bentall+Debranch+TEVAR,and 20 cases underwent aortic root plasty+ascending aorta replacement+Debranch+TEVAR.No persistent neurological dysfunctions such as unilateral paralysis,paraplegia,and coma were found.One case experienced confusion,4 cases experienced agitation,and 2 cases experienced delirium.There were 15 cases of hypoxemia,4 cases of tracheotomy,and 5 cases of renal failure that received continuous renal replacement therapy.The delayed thoracotomy,secondary thoracotomy for hemostasis,and chylothorax did not occur.During the follow‐up period of 6‐12 months,2 patients died,including 1 patient with cerebral hemorrhage and 1 patient with severe infection(Klebsiella pneumonia).Conclusion:TypeⅡhybrid total aortic arch repair has achieved a satisfactory therapeutic effect in the treatment of Stanford type A aortic dissection,which could avoid deep hypothermic circulatory arrest,shorten the time of operation and cardiopulmonary bypass,and significantly reduce the incidence of perioperative complications and mortality.