To Compare The Perioperative Clinical Effect Of Sun’s Procedure On Subdivided Type A Aortic Dissection

Objective: Sun’s procedure is currently the standard surgical procedure for type A aortic dissection,and it is also a common surgical method for the treatment of type A aortic dissection in our center.According to the refined classification of aortic dissection,this study compared and analyzed the perioperative clinical efficacy of Sun’s operation in patients with type A aortic dissection,in order to explore whether there is any difference in the perioperative clinical effect of Sun’s procedure on type A aortic dissection with different types of aortic dissection.Methods:A total of 120 patients with type A aortic dissection who underwent Sun’s procedure in the first affiliated Hospital of Guangxi Medical University from January 2013 to May 2019 were selected.According to the subtypes of aortic dissection,aortic dissection was divided into three types:A1C,A2 C and A3 C,which were divided into three groups: group A(type A1C),group B(type A2C)and group C(type A3C).The proximal end of the aorta was treated with aortic valvuloplasty,ascending aortic replacement or Bentall according to the actual condition.Sun’s operation was performed on the aortic arch of all patients.The survival rate and complications were observed and discharged from hospital.For the patients who died,the time of death was taken as the last observation time.The general condition of patients before operation,operation and short-term clinical effect after operation were compared and analyzed.Results: There were significant differences among the three groups in the amount of plasma transfused during Bentall operation,ascending aortic replacement,simultaneous aortic valvuloplasty(AVP),aortic occlusion time,and 24 h after operation.The proportion of Bentall operation in group A was significantly lower than that in group B(5% vs 88.9%)and group C(5% vs100%);the proportion of ascending aortic replacement in group A was significantly higher than that in group B(95% vs 11.1%)and group C(95% vs0);the proportion of AVP operation in group A was significantly higher than that in group C(30% vs 0%),but there was no significant difference with group B;the time of aortic blockage in group A was 106.00(93.75,124.25)min,which was significantly lower than that of 125.00(111.50,146.50)min in group B and124.00(106.00,143.00)min in group C.The plasma transfusion volume of1400(1025,1637.5)ml in group A during and 24 h after operation was significantly lower than that of 1900(1600,2100)ml in group C during and 24 h after operation.There were significant differences in mortality,incidence of low cardiac output syndrome and ICU stay among the three groups;the mortality rate in group A was significantly lower than that in group C(2.5% vs22.9%).The incidence of low cardiac output syndrome in group A was significantly lower than that in group B(2.5% vs 20%)and group C(2.5% vs31.4%),but there was no statistical difference between group B and group C.The length of ICU stay in group A was significantly lower than that in group C.The other indicators showed no statistical difference.Conclusion:1.The perioperative mortality of Sun’s procedure in patients with type A3 C was higher than that in patients with type A1 C.2.The incidence of perioperative low cardiac output syndrome was higher in type A2 C and A3 C patients undergoing Sun’s procedure than in type A1 C patients.