Study On The Effect Of Proximal "Sandwich" Technique On The Prognosis Of Aortic Valve After Acute Aortic Dissection Surgery

Background and Objective:Aortic dissection belongs to severe cardiovascular disease.The number of surgery grows fast due to the accurate diagnosis of AD in recent years.Acute DeBakey type I dissection is a type of lesion involving the ascending aorta,aortic arch and descending aorta.The goal of treatment is to prevent progression of dissection and fatal complications.Open surgery is still the gold standard for the treatment of acute type I aortic dissection,which is mainly aimed at the vascular replacement of the ascending aorta and repair of aortic root and aortic valve.Type I aortic dissection of non-MFS patients frequently has no aortic sinus enlargement and aortic regurgitation.For this reason,aortic sinus and aortic valve can be preserved."Sandwich" technique is taken in treatment of the proximal ascending aorta,in which two using felt strips or other material for reinforcement of the anastomosis."Sandwich" technique strengthens the anastomosis of the proximal ascending aorta,and reduces blood oozing of anastomosis.On the other hand,the technique prevents the continued development of dissection by occluding false lumen.However,there are some potential dangers in using "sandwich"technique."Sandwich" closed proximal aortic false lumen,but blood may still get into the false lumen from the anastomosis due to proximal aortic high blood pressure,so that the dissection could progress to the root avulsion,resulting in aortic sinus enlargement and structure of aortic annulus changing.Finally aortic valve regurgitation is developed.This study is based on non-MFS acute I aortic dissection patients adopts,sandwich" technology for the treatment of proximal ascending aorta in recent years in our hospital.Evaluate the feasibility of the "sandwich" technique for acute type I aortic dissection by analyzing aortic regurgitation of postoperative follow-up.Methods:Retrospective study 177 patients with aortic dissection of the First Affiliated Hospital of Zhejiang University from 2007 to 2016.Excluding 52 cases of DeBakey type Ⅱ,Ⅲ and patients with MFS,the number of non-MFS acute type I aortic dissection is 125.Among these,93 cases adopt "sandwich" technology for the treatment of proximal ascending aorta.13 cases occurr hospital death and 7 cases lost follow-up.Observe the aortic valve regurgitation by echocardiography for these 73 cases including in this study.And evaluate the feasibility of the "sandwich" technique in reinforcement of proximal ascending aorta.Results:73 patients of non-MFS acute type I aortic dissection in using "sandwich"technique in reinforcement of proximal ascending aorta were included in this study.Average age is 51.5±10.9,the male to female ratio is 3:1.67.1%patients have history of hypertension.The average follow-up time was 14.8±16.6 months.8 patients died during follow-up.3 patients’ diameter of aortic sinus increased for more than 5 mm.However,no aortic valve regurgitation happened in these 3 patients.There were 3 patients presenting moderate aortic valve regurgitation during follow-up,but no obvious dyspnea or chest pain came out.And the diameter of aortic sinus of these patients was normal.Conclusion:"Sandwich" technique in reinforcement of proximal ascending aorta is widely used in aortic dissection surgery.3 patients showed moderate aortic valve regurgitation during follow-up.Due to the low occurrence rate(4.1%)and living quality of these patients are not obviously influenced in our study,"sandwich" technique of proximal ascending aorta would not seriously affect aortic valve.