Application Of Simplified Arch-first Technique In Aortic Arch Replacement And Sun’s Procedure

Objective:Exploring the application of simplified arch-first technique in aortic arch replacement and Sun’s procedure.Discussing surgical methods,technical points,surgical indication,and clinical efficacy and safety evaluation.It is expected to provide new improvements and development directions for the surgical options of acute and chronic Stanford type A aortic dissection,aortic arch aneurysms,and pseudoaneurysms.Methods:Thirteen patients admitted to Qilu Hospital of Shandong University from April 2018 to January 2019,11 of whom were complicated acute Stanford type Aaortic dissection,(aortic dissection),1 aortic arch aneurysm,and 1 case A patient with aortic arch pseudoaneurysm.Preoperative,intraoperative,and postoperative data were collected from patients.Preoperative data included gender,age,coronary heart disease,hypertension,history of diabetes,left ventricular ejection fraction,other cardiac disease,nervous system dysfunction,acute renal function failure,limb ischemia,abdominal organ ischemia.Intraoperative data including intraoperative images,autologous bypass time,cardiopulmonary bypass time,aortic occlusion time,selective cerebral perfusion with deep hypothermic circulatory arrest time,assisted time.Postoperative data included ventilator assisted ventilation tiine,cardiac and pulmonary complications,central nervous system complications,acute liver and kidney dysfunction,etc.Follow-up data included symptoms,computed tomography angiography(CTA),and echocardiography,new complications,cardiovascular reoperation,etc.Surgery patients were underwent intubation to establish the autologous bypass,from femoral artery to right subclavical artery/innocent artery,and left common carotid artery.After autologous bypass,all patients underwent replacement of aortic arch branch vessels in the autologous bypass,and then underwent Sun’^surgery or aortic arch replacement under cardiopulmonary bypass.There were 8 males and 5 females,aged 40-61 years old.3 patients got acute type A aortic dissection after covered endovascular stent-graft surgery,6 patients had hypertension.There were 2 cases of aortic regurgitation,3 cases of coronary artery disease,1 case of important organ ischemia(kidney insufficiency)and 1 case of bovine aortic arch.At the same time,2 patients underwent coronary artery bypass grafting,1 underwent Wheat procedure,1 underwent Bentall procedure,and other 9 patients underwent sinus reconstruction.Results:1.The cerebral perfusion time by autologous bypass from femoral artery/innominate artery to right axillary artery and left common carotid artery was(35.6±7.9)min,cardiopulmonary bypass time(231.3±50.6)min,aortic clamp time(125.9±22.4)min,selective cerebral perfusion with deep hypothermic circulatory arrest time(22.9±3.0)min,1 patient died in hospital,the main reason of death was severe coronary heart disease complicated with severe coronary artery injury,which leading to low cardiac output syndrome,and CABG could not be effective.2.The branches of the aortic arch were clearly developed,and the true cavity of the dissection was significantly enlarged compared with the preoperative period,the false cavity formed thrombosis.The heart function and activity was of patients was normal or improved compared with preoperative.Conclusion:Simplified arch-first technique for the treatment of acute aortic dissection,aortic arch aneurysm and pseudoaneurysm patients is safe and effective,and the short-term effect is good.