SUN’s Operation And Ascending Aorta Replacement Combined With Open Placement Of Triple-branched Stent Graft For Acute Type A Aortic Dissection

Objective： To summary the experience and improve the long term outcomesof the surgery for acute type A dissection,we performed SUN’S operation(ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta) and ascending aortareplacement combined with open placement of triple-branched stent graft for acutetype A aortic dissection.Methods： Records of the General Hospital of Ningxia Medical Universitydatabase between2011and2013were examined. The modified classification ofthe aortic dissection diagnosis codes were used to select patients who underwentSUN’S operation or ascending aorta replacement combined with open placementof triple-branched stent graft. We selected patients with a diagnosis code for ACtype dissections which was mentioned in the subtype of aortic dissection.Wecompared demographics and comorbidities, as well as adjusted complications andmortality rates, between patients undergoing SUN’S operation vs opentriple-branched stent graft placement.Results： SUN’S operation: the mean cardiopulmonary bypass time, aorticcross-clamp time, and average selective cerebral perfusion and lower body arresttime were (253.33±49.33)min,(141.41±27.58)min,(39.67±10.28)min,respectively. The in-hospital mortality was4/12for SUN’S Operation vs2/12foropen triple-branched stent graft placement, respiratory complications (1/12vs 1/12), multiorgan failure postoperatively (2/12vs1/12), and acute renal failure(3/12vs3/12) in SUN’S operation group and open triple-branched stent graftplacement. In open triple-branched stent graft placement, there was no sidearmgraft stenosis or occlusion, but1space or blood flow surrounding thetriple-branched stent graft following hospital discharge, and1case died afterleave hospital.Conclusion： For patients with a diagnosis of AC type acute dissection. BothSUN’S operation group and open triple-branched stent graft placement areeffective technique with satisfactory early results. With the open triple-branchedstent graft placement, extensive primary repair of the thoracic aorta may becomeeasier and safer for acute type A aortic dissection. Careful long-term follow-up,further extensive clinical trials and personalized information customization foropen triple-branched stent graft placement are necessary before this surgicalmethod can become a recommended alternative to surgical extensive primaryrepair of the thoracic aorta for acute type A aortic dissection.