Clinical Efficacy Comparison And Etiological Discussion Of Different Surgical Procedures On Stanford Type A Aortic Dissection

Objective To analyze the near-term clinical efficacy of two different surgical procedures(Sun's Procedure and Debranching combined endovascular stent-graft procedure)to cure Stanford type A aortic dissection,and summarize the clinical experience to help better master the indications of the two surgical procedures;At the same time,analyze onset seasons,race,blood type and other factors of these patients,to make a preliminary probe of the correlation between these factors and the occurrence of this disease.Methods Taking the 46 patients of department of Cardiovascular Surgery in the Second Affiliated Hospital of Lanzhou University from September 2014 to September 2017,diagnosed with an acute Stanford type A aortic dissection and had undergone Sun's procedure or Debranching combined endovascular stent-graft procedure,as the research object.And according to different surgical methods,divided into Sun's procedure group(26 cases)and Debranching combined endovascular stent-graft procedure group(20 cases);Comparing the ACC time,CPB time,intraoperative urine output,volumes of infused blood,postoperative mechanical ventilation time,postoperative volumes of drain,CICU time,total hospital stay and other indicators;analyze onset seasons,race and blood type of the patients;and after discharged 3 months,6 months,1 year later,review angiography and echocardiography to follow-up.Results The operation of the two groups was successfully completed.Debranching combined endovascular stent-graft procedure group was significantly superior to the Sun's group in CPB time,ACC time,intraoperative urine output,postoperative mechanical ventilation time,postoperative 24 h volumes of drain,CICU time,renal function recovery of postoperative 72 h and total hospital stay.The incidence of transient neurological damage after operation wassignificantly lower than that of Sun's procedure group;The follow-up time ranged from 3 to 36 months,And the follow-up rate was 90.5%.One patient in Sun's procedure group,died of serious pulmonary infection postoperative 30 days.One patient in Debranching combined endovascular stent-graft group was found to have internal leakage in the early postoperative examination and disappeared after 6 months;Sun's procedure group did not find endoleak.All patients during the follow-up time did not appear brain,coagulation disorders,stroke,paraplegia,upper limb ischemia and other complications.The onset seasons of all the patients was mostly spring and autumn,in which October was the high season.And the O blood type had the highest proportion and the AB blood type had the lowest proportion.Conclusion Although Debranching combined endovascular stent-graft procedure has a risk of postoperative endoleak,comparing to Sun's procedure,the overall curative effect has a certain superiority.Therefore,for Stanford type A aortic dissection,it is preferable to choose the Debranching combined endovascular stent-graft procedure;And the disease often occurs in the spring and autumn;Morbidity is high that patients with blood type O,but the correlation between blood type and incidence of the disease,still need further investigation and study to confirm.