A Comparison Of Sun's Operation And Ascending Aorta Replacement Combined With Open Placement Of Triple-branched Stent Graft In Type A Aortic Dissection

Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using Sun's operation and triple-branched stent graft.Methods Preoperative examinations include cardiac ultrasound, CTA, hepatic and renal function and blood routine in all patients. Intraoperative monitor the index about cardiopulmonary bypass and blood loss. Hepatic and renal function and complications in the perioperative are also recorded. Survival and recovery of patients were evaluated by follow ups. Thirty-three type A aortic dissection patients admitted to Tianjin Chest Hospital by surgery from January 2009 to December 2014 were included in this study. Among these patients, 22 received total arch replacement combined with stented elephant trunk implantation(Sun's group), and 11 received triple branches aortic arch stent-graft placement(triple-branched group). Patients were followed up prospectively by contrast-enhanced computed tomographic scan and echocardiographic examination before discharge, 6 months after the surgery, and annually thereafter.Results There were six cases of perioperative death in Sun's group. And three of patients died in triple-branched group. In triple-branched group, the intraoperative blood loss was significantly increased than that in Sun's group[(3 586.4±2 926.8)m L vs(2630.5±1821.2)m L,P<0.05]. Postoperative echocardiographic examinations revealed the left ventricular size and the aortic diameter was decreased while the left ventricular ejection fraction was elevated after surgery in Sun's group[(50.9±6.9)mm vs(55.0±7.5)mm, P<0.05,(28.2±1.6)mm vs(48.8±11.0)mm,P<0.05,(0.620±0.031) vs(0.469±0.104), P<0.05]. Whereas, only the aortic diameter was decreased in triple-branched group[(28.6±3.9)mm vs(50.9±9.2)mm, P<0.05]. Kaplan-Meier survival curve showed that five-year survival rate of Sun's group was similar with triple-branched group(Log-rankc2=0.095, P>0.05). At 5 year after operation, there was no significant difference between Sun's group and triple-branched group with recurrence of new aortic dissection, the incidence of cerebral infarction, mortality.(P>0.05).Conclusion Sun's operation can significantly decrease patient's intraoperative blood loss and better remote cardiac function.But its survival rate and long term results need advanced observation.