Analysis Of Clinical Characteristics And Surgical Treatment On 38 Cases Of Stanford Type A Aortic Dissection

Object: To summarize the clinical characteristics and experiment of surgical treatment of Stanford type A aortic dissection, explore the choice of surgical pattern.Method: Thirty-eight consecutive patients with Stanford type A aortic dissection underwent surgical treatment from January 2003 to March 2009 was retrospectively reviewed, 28 cases of male and 10 cases of female, mean age 50.58±10.63 years. Actue period in 27 cases. 30 cases of Debakey type I, 8 cases of Debakey type II. Hypertension in 27 cases. 5 patients of Marfan syndrome, one had previously underwent surgical treatment due to Stanford type B aortic dissection. Cardiac tamponade and heart shock in 3 cases. Development of retrograde Stanford type A aortic dissection during endovascular stent grafting for Stanford type B aortic dissection in one case. Supracommissural tube graft replacement in 14 cases, resuspension of the aortic commissures in 8 cases. Mechanical composite graft replacement (Bentall procedure) in 8 cases, an aortocoronary bypass (coronary artery bypass grafting, CABG) with a saphenous vein graft (SVG) in 5 cases. Ascending aortic graft + total arch replacement + stented elephant truck technique in the thoracic descending aorta in 8 cases. Ascending aortic graft + hemi-arch replacement in 7 cases. Simple noncoronary sinus resection in 4 cases. Separate replacement of aortic valve and supracommissural ascending aorta (Wheat procedure) in 3 cases. Valve-preserving partial aortic root remodeling (David II procedure) in 1 case. Cardiac arrest was obtained by antegrade administration in the coronary ostia and retrograde administration into the coronary sinus with cold crystalloid cardioplegia. All patients underwent surgery on cardiopulmonary bypass (CPB). Deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (SACP) through right subclavian (axillary) artery or/and left common carotid artery were performed in 33 cases, 5 under CPB with intermediate hypothermia.Results:The operative death in 4 cases (mortality rate was 10.53 %),low output syndrome in 3 cases. There was no serious neuronal dysfunction. Postoperative re-exploration for hemorrhage of anastomosis in 2 cases. CPB time was 115～645min,with a mean of (246.79±117.99) min, Aortic cross clamp(ACC) time was 48～380min,with a mean of (120.13±62.27) min , SACP and lower body arrest time was 12～100min, with a mean of (26.76±16.92) min. Transfusion of concentrated red blood cell was 0～20U , with a mean of (7.03±5.59) U, of platelet was 0～6 bags, with a mean of (1.03±1.17) bags, of plasma was 0～6140ml, with a mean of (1541.58±1037.08)ml, of cold deposition was 0～10 bags, with a mean of (2.63±4.31)bags. The in-hospital time is 1～33days, with a mean of(9.84±6.52)days. One patient died of multi-organ failure (MOF) 2 months after operation.Conclusion:1. Surgical treatment of Stanford type A aortic dissection is necessary and reliable.2. The suitable choice of surgical pattern according to intimal tear site and extent of dissection together with good manipulative technique is the cornerstone of improving the survival rate.3. DHCA combined with SACP is an effective way of cerebral protection against neurological dysfunction.4. The problem of operative bleeding is still challenging.