Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to Oct...Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25展开更多
Objectives To review the indications, operative methods and postoperative management of the “elephant trunk technique”, and to report two cases of DeBakey type Ⅰ aortic dissection treated with the “elephant trunk...Objectives To review the indications, operative methods and postoperative management of the “elephant trunk technique”, and to report two cases of DeBakey type Ⅰ aortic dissection treated with the “elephant trunk technique” Methods Two cases of DeBakey type Ⅰ aortic dissection were operated with selective cerebral perfusion via the right subclavian artery At the first stage, a tubular dangling aortic graft prosthesis (“elephant trunk”) was inserted into the distal aorta while replacing the ascending aorta and aortic arch The distal elephant trunk prosthesis was then used at the second stage involving the replacement of the sections of the distal aorta via a left sided thoracotomy Results The two operations were successful Ultrafast computed tomograph (UFCT) showed that the two patients were cured after the first stage operation, and the second stage procedure could have been avoided Conclusions The “elephant trunk technique” is a multiple stage approach in the treatment of extensive aneurysmal diseases of the aorta The procedure is indicated for patients who have combined diseases of both ascending aorta plus aortic arch segments and descending aortic aneurysm It can also be used for patients with DeBakey type Ⅰ aortic dissection Some patients can be cured after the first stage operation展开更多
Background Aortic dissection（AD） is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the compl...Background Aortic dissection（AD） is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient＇s condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group（≤ 2 w）, and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group（〉 2 w）, and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%（37/231） in the acute group, while 6.1 %（6/99） in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass（CPB） time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group（P 〈 0.05）. The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group（P 〈 0.05）. Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.展开更多
目的探讨孙氏手术治疗A型主动脉夹层(Type A aortic dissection,TAAD)的临床效果。方法回顾性分析2014年5月至2018年7月于重庆医科大学附属第一医院胸外科心脏/大血管外科实施全主动脉弓置换加支架象鼻术(孙氏手术)的60例A型主动脉夹层...目的探讨孙氏手术治疗A型主动脉夹层(Type A aortic dissection,TAAD)的临床效果。方法回顾性分析2014年5月至2018年7月于重庆医科大学附属第一医院胸外科心脏/大血管外科实施全主动脉弓置换加支架象鼻术(孙氏手术)的60例A型主动脉夹层患者。所有患者均经电子计算机断层扫描血管造影(Computed photograph angiography,CTA)确诊为TAAD,均采用低温停循环联合脑灌注脑保护,最终实施孙氏手术,根据主动脉根部情况,行单纯升主动脉置换、Bentall或David手术。结果60例患者均手术成功,全组体外循环时间(270±68)min,主动脉阻断时间(162±43)min,脑灌注时间(41±14)min,住院期间死亡7例,3例死于术后出血,3例死于术后多器官功能衰竭,1例死于恶性心律失常;术后并发肺部感染4例,胸骨哆开3例,脓毒血症3例,术后脑卒中1例,乳糜胸1例,声带麻痹1例,急性肾功能不全经透析治疗5例,二次手术5例。出院后30 d无死亡病例,行血管内腔内隔绝2例。结论孙氏手术是治疗广泛撕裂的TAAD的安全有效的方法,根据病情选择恰当的外科处理近期治疗效果令人满意。展开更多
文摘Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25
文摘Objectives To review the indications, operative methods and postoperative management of the “elephant trunk technique”, and to report two cases of DeBakey type Ⅰ aortic dissection treated with the “elephant trunk technique” Methods Two cases of DeBakey type Ⅰ aortic dissection were operated with selective cerebral perfusion via the right subclavian artery At the first stage, a tubular dangling aortic graft prosthesis (“elephant trunk”) was inserted into the distal aorta while replacing the ascending aorta and aortic arch The distal elephant trunk prosthesis was then used at the second stage involving the replacement of the sections of the distal aorta via a left sided thoracotomy Results The two operations were successful Ultrafast computed tomograph (UFCT) showed that the two patients were cured after the first stage operation, and the second stage procedure could have been avoided Conclusions The “elephant trunk technique” is a multiple stage approach in the treatment of extensive aneurysmal diseases of the aorta The procedure is indicated for patients who have combined diseases of both ascending aorta plus aortic arch segments and descending aortic aneurysm It can also be used for patients with DeBakey type Ⅰ aortic dissection Some patients can be cured after the first stage operation
基金supported by The Medical Scientific Research Foundation of Guangdong Province(No.A2016028/No.A2015458)
文摘Background Aortic dissection（AD） is a life-threatening surgical emergency. Total arch replacement combined with stent trunk has gradually become the standard procedure for De Bakey type Ⅰ AD in China, but the complication and mortality rates are still relatively high due to surgical technical difficulties and complexity. In principle, AD should be treated with emergency surgery once the diagnosis is confirmed, but the operation time varies greatly in China due to the restriction of medical conditions. Therefore, analyzing and comparing the surgical mortality and complications rate between acute and chronic phase may facilitate the clinicians to comprehensively evaluate the patient＇s condition, and thus select an appropriate operation timing. Methods A total of330 De Bakey type Ⅰ AD patients admitted and treated with total arch replacement combined with stent trunk procedure in Guangdong Cardiovascular Institute from Jan 2010 to Jan 2014 were retrospectively analyzed. According to whether the onset was longer than 2 w, patients were divided into acute phase group and chronic phase group. There were 231 cases in acute phase group（≤ 2 w）, and the average length from onset to operation was 5.6± 3.8 d; while 99 cases in chronic phase group（〉 2 w）, and the average length from onset to operation was 20.6 ±14.7 d. Results The total mortality rate was 13%. Acute renal failure, neurological dysfunction, and wound healing were the major complications after operation. The in-hospital morality rate was 16.0%（37/231） in the acute group, while 6.1 %（6/99） in the chronic group. The surgical data of the ratio of CABG, cardiopulmonary bypass（CPB） time, aortic cross clamp time, intra-operative RBC infusion were significant higher in the acute phase group（P 〈 0.05）. The postoperative data of ICU stay, mechanical ventilation time, the incidences of neurological dysfunction, CRRT-dependent acute renal failure, hepatic insufficiency, and poor wound healing were significant higher in the acute phase group（P 〈 0.05）. Conclusions The total arch replacement combined with stent trunk for De Bakey type Ⅰ aortic dissection is safe and effective. Patients in the acute phase show higher postoperative mortality and complications. The acute phase is associated with relatively higher risk of surgical treatment.
