Single Center Clinical Analysis Of Stanford Type A Aortic Dissection

Objective To summarize the efficacy of surgical treatment of Stanford A aortic dissection in Department of Cardiovascular surgery,General Hospital of Ningxia Medical University,and to evaluate the changes in the diagnosis and treatment of aortic dissection in the past three years and the previous three years.Summarize the clinical experience and improve the diagnosis and treatment effect of this kind of patients.The independent risk factors of poor prognosis after Total aortic arch replacement and stent trunk surgery were identified by univariate and multivariate analysis.Methods The clinical data of 221 cases of Stanford type A aortic dissection treated in our hospital from January 2017 to December 2022 were analyzed retrospectively.The patients admitted from 2017 to 2019 were defined as the early group,and the patients from 2020 to 2022 were defined as the short-term group.The baseline data,intraoperative and postoperative clinical data were collected,and the early and short-term diagnosis and treatment changes in our center were compared.According to the occurrence of early bad prognosis,Total aortic arch replacement and stent trunk surgery patients were divided into poor prognosis group(n=54)and non-poor prognosis group(n=113),and univariate and multivariate logistic regression analysis was performed by SPSS26.0 statistical software to determine the independent risk factors of early postoperative poor prognosis.Results After surgical treatment of 221 patients with Stanford type A aortic dissection,25 patients died in hospital,with a hospital mortality rate of 11.31%.10 patients left the hospital automatically,and the rest of the patients recovered well when they were discharged.Compared with the patients with early treatment and recent treatment in our center,it was found that the proportion of patients with type A aortic dissection with hypertension increased significantly(early vs recent 63.77%vs83.55%P=0.001).Total aortic arch replacement and stent trunk surgery is the main method for the treatment of aortic dissection involving arch lesions in our center,which accounts for 93.40% of the total arch operations.Compared with the intraoperative indexes of the early group and the short-term group,the short-term average time of circulatory arrest in the arch operation group was shorter than that in the early stage(early vs recent,26.07 ± 7.36 vs24.09 ± 8.31 min,P=0.031),and the cardiopulmonary bypass time in the short-term group was less than that in the early group(early vs recent,214.38 ±30.70vs203.33 ±60.21 min,P=0.002).The use of bilateral antegrade cerebral perfusion technique in the recent group was significantly higher than that before(early vs recent 20.30%vs82.89% P<0.001).Multivariate Logistic regression analysis showed that preoperative liver function injury(OR=8.51,95%CI1.47-49.05,P<0.05),cardiopulmonary bypass time(OR=1.01,95%CI1.00-1.03,P<0.05),postoperative mechanical ventilation time(OR=1.02,95%CI1.00-1.03,P<0.05)and postoperative intensive care unit retention time were prolonged(OR=1.01,95%CI1.00-1.02,P<0.05)is an independent risk factor for poor prognosis after Total aortic arch replacement and stent trunk surgery.Conclusion 1.Surgery is an effective method for the treatment of Stanford type A aortic dissection.2.Compared with the early and recent treatment patients in our center,it was found that the proportion of type An aortic dissection with hypertension increased significantly in the short-term group(early vs recent,63.77%vs83.55% P=0.001),and the number of patients with Stanford type An aortic dissection with hypertension gradually increased,so it is necessary to strengthen the health education of aortic dissection and strengthen the awareness of reasonable control of hypertension in patients with hypertension.3.With the accumulation of the number of patients with type A aortic dissection,the surgical skill level and postoperative patient management ability of our center in the treatment of aortic dissection continue to improve,which will continue to improve the therapeutic effect of this kind of disease.4.Preoperative liver function injury,increased cardiopulmonary bypass time,prolonged postoperative mechanical ventilation time and postoperative intensive care unit retention time are independent risk factors for poor prognosis after Total aortic arch replacement and stent trunk surgery.