| Objective:To evaluate the treatment of aortic root with modified "sandwich" method by comparing the intraoperative and prognosis of aortic root management with modified "sandwich" method and the application of artificial blood vessel and end-to-end aortic anastomosis with Cabrol shunt in ATAAD safety and effectiveness.Methods:A retrospective analysis was performed between June 2017 and June 2021 in the Second Affiliated Hospital of Nanchang University,who were diagnosed as ATAAD by thoracic and abdominal CTA,and underwent ascending aortic replacement + total aortic arch replacement and descending aortic elephant trunk stent implantation(The clinical data of 134 patients.Among them,there were 107 males(79.9%)and 27females(20.1%),with an average age of 53.00±8.97(28-77)years,and an average body mass index of 26.07±4.36.Among them,102(76.1%)had a history of hypertension and diabetes.4 cases(2.9%),3 cases(2.2%)of cerebral infarction,2cases(1.5%)with a history of renal disease,16 cases(11.9%)of aortic valve regurgitation showed no or slight regurgitation by echocardiography,and 73 cases of mild regurgitation(54.5%),19 cases(14.2%)of mild to moderate reflux,20 cases of moderate reflux(14.9%),4 cases of moderate to severe reflux(3.0%),2 cases of severe reflux(1.5%).According to the different treatment methods of the aortic root during the operation,all patients were divided into a modified "sandwich" group(hereinafter referred to as the modified group)of 88 cases and the artificial blood vessel anastomosed with the aorta end-to-end.Afterwards,46 patients underwent Cabrol shunt(hereinafter referred to as the control group),and all clinical data during hospitalization and follow-up between the two groups were compared.Preoperative data mainly included the patient’s general condition,medical history,poor perfusion,initial test results and preoperative test results;intraoperative data mainly included operation time,cardiopulmonary bypass time(CPB),aortic occlusion time,and post-concurrent time.,intraoperative leukocyte red blood cell suspension volume,intraoperative plasma transfusion volume,etc.;postoperative data mainly include drainage volume on the first postoperative day,mechanical ventilation time,blood transfusion volume in 24 hours after surgery,postoperative hospitalization time,and ICU hospitalization time,postoperative complications;follow-up data mainly include death,aortic root dilatation and so on.Combined with the above data,the safety and efficacy of the modified "sandwich" method in the treatment of aortic root were comprehensively evaluated.Results:In this study,the preoperative data(general condition,past history,poor perfusion,initial test results and preoperative test results),intraoperative data(aortic occlusion time,post-concurrent time,intraoperative transfusion of red suspension volume,intraoperative plasma transfusion volume),postoperative data(postoperative complications,drainage volume on the first day(ml),postoperative 24-hour plasma transfusion volume(ml),postoperative 24-hour red suspension volume(U),The postoperative hospital stay(days))and follow-up data(death,aortic root dilatation)were statistically analyzed,and there was no statistical significance(all P>0.05).The operation time of the modified group(474.21±74.58)was significantly shorter than that of the control group(510.00±91.21);the cardiopulmonary bypass time of the modified group(187.89±37.01)was significantly shorter than that of the control group(201.63±30.59);the mechanical ventilation of the modified group The time(25.06±18.34)was shorter than the mechanical ventilation time of the control group(38.15±23.30);the hospital stay in the cardiac surgery ICU of the improved group(77.82±45.07)was significantly shorter than that of the control group(109.38±57.08),with statistical significance(P values are <0.05).Follow-up data(death,aortic root dilatation,degree of aortic regurgitation,aortic valve sinus diameter)were not statistically significant.Conclusion:In ATAAD,applying the modified "sandwich" approach to the aortic root can shorten the duration of cardiopulmonary bypass,with comparable postoperative complications and mortality,and no difference in recent follow-up results.Safety and efficacy of a modified "sandwich" approach in aortic root management. |
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