| Objective:Analysis using the aortic root retention and the ascending aorta wall technique in the treatment of Stanford type A aortic dissection after the surgery effect obtained,and the total。Research objects and methods:The clinical data of patients with acute Stanford type A aortic dissection performed by the same operator in the Department of Cardiac surgery of the third affiliated Hospital of Xinxiang Medical College and the first people’s Hospital of Shangqiu City from September 2020 to December 2022 were retrospectively analyzed.Case selection criteria:(1)CTA clearly diagnosed type An aortic dissection(AAD).(2)dissection range did not involve the posterior wall of the ascending aorta.(3)there were no operative contraindications before operation.Observation indicators: the general and special examination data of the patients before operation,including thoracic and abdominal CTA results,confirmed that the structure of the posterior wall of ascending aorta was normal,and the aortic root was evaluated by echocardiography before and after operation,including aortic diameter,ejection fraction,end-diastolic volume,aortic valve regurgitation area,etc.Collect perioperative data,including cardiopulmonary bypass time,aortic clamping time,deep hypothermic circulatory arrest time,intraoperative erythrocyte infusion,postoperative 24-hour drainage,intensive care time,postoperative mechanical ventilation time,postoperative complications,hospital stay,postoperative outcome,etc.Methods: the internal diameter of aorta,aortic regurgitation area,LVEF and LVEDD of all patients before and after operation were statistically compared and analyzed.Combined with the above observation indexes,the surgical effect of preserving aortic root and posterior wall of ascending aorta was evaluated comprehensively,and the clinical experience was summarized.Follow-up methods: postoperative and recent 3 months were followed up through outpatient clinic,We Chat and telephone.Aortic root reconstruction and aortic valve regurgitation were evaluated by reexamination of thoracic and abdominal CTA and echocardiography.Statistical methods: SPSS26.0 software was used for data statistics and analysis,the counting data were described by the number of cases and the percentage of the total,the measurement data of normal distribution were described by mean ±standard deviation,and the measurement data of skewed distribution were described by quartile(P < 0.05).The data before and after operation were analyzed by paired pair test.Results:There were 34 cases in this group,including 27 males(79.4%)and 7 females(20.6%),with an average age of 53.1 ±12.8(28~74)years.Past history of hypertension in 16 cases(47.1%),diabetes in 5 cases(14.7%),coronary heart disease in 2 cases(5.9%),cerebrovascular disease in 1case(2.9%),kidney disease in 1 case(2.9%),The history of lung disease was 1 case(2.9%).Before operation,aortic diameter,aortic regurgitation area,ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD)were 43.4 ±9.4 mm,6.4 ±2.6 cm2,60.3 ±4.9% and46.9 ±5.9%,respectively.Stanford type A aortic dissection was treated with preservation of aortic root and posterior wall of ascending aorta.1 case died during operation and 1 case underwent secondary thoracotomy to stop bleeding.The operation time was 360.0(330.0,411.2)min,the cardiopulmonary bypass time was 140.0(125.8,169.5)min,the aorta occlusion time was(88.7±34.1)min,the deep hypothermia circulatory arrest time was(18.1 ± 2.9)min,and the intraoperative red blood cell infusion was 6.0(4.0)U.24 hours after operation,the drainage volume was 695.0(357.5,953.3)m L,the postoperative mechanical ventilation time was 22.0h,the intensive care unit time was 4.0d,and the total hospital stay was 19.0d.Thoracic and abdominal CTA and echocardiography were used to evaluate the aortic root,including aortic diameter(30.6 ±4.7)mm,aortic regurgitation area(1.4 ±0.6)cm2,LVEF(58.2 ±5.2)% and LVEDD(48.3 ±4.9)%.There were 16 cases(48.48%)of pulmonary infection,7 cases(21.21%)of pleural effusion,3 cases(9.09%)of acute renal injury and 2 cases(6.06%)of acute brain injury.After operation,29 cases were cured(85.30%),3 cases(8.82%)died in hospital,and 2 cases(5.88%)were discharged automatically.29 patients(85.30%)were followed up 3 months later,and there was no death after discharge.Echocardiography of thoracic and abdominal CTA aorta and heart showed that there was no recurrent dissection and internal leakage,aortic valve regurgitation had no significant change compared with discharge,and no severe regurgitation occurred.The preoperative and postoperative aortic diameter,aortic regurgitation area,ejection fraction and end-diastolic volume were statistically analyzed.The postoperative aortic diameter(30.6 ± 4.7)mm was significantly smaller than that of the preoperative aortic diameter(43.4 ± 9.4)mm,and the postoperative aortic regurgitation area(1.4 ± 0.6)cm2 was significantly lower than that of the preoperative aortic regurgitation(6.4 ± 2.6)cm2.There was no significant difference in LVEF and LVEDD before and after operation.The operation of preserving aortic root and posterior wall of ascending aorta was used to treat Stanford type A aortic dissection.the condition of aortic root was stable and the curative effect of diagnosis and treatment was definite.Conclusion:Ascending aortic angioplasty with preservation of aortic root and posterior wall of ascending aorta is an effective new method for surgical treatment of Stanford type A aortic dissection.This method can shorten the operation time,reduce perioperative blood loss,retain its own aortic valve and aortic sinus ascending aorta,and avoid lifelong anticoagulation complications after operation.the short-term effect is satisfactory and the long-term effect needs further observation. |
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