Study Of Surgical Management For Acute Stanford Type A And Stanford Type B Aortic Dissection

Objective (1) To review the experience of stented elephant trunk graft implantation into the descending aorta procedure combined with ascending aorta and total aortic arch replacement for acute Standford type A aortic dissection. (2) To evaluate the effect of ascending aorta cannulation and left subclavian artery windowing and study the applicability of modified bilateral antegrade selective cerebral perfusion during acute Standford type A aortic dissection surgery. (3)To assess the outcome of stented elephant trunk (SET) surgical approach for acute Standford type B aortic dissection.Methods (1) From January 2003 to January 2011,112 consecutive patients with acute Standford type A aortic dissection underwent stented elephant trunk graft implantation into the descending aorta procedure combined with ascending aorta and total aortic arch replacement, were further divided into subgroups according to the way of intubation and Cerebral protection. The in-hospital mortality rate and complication rate were analysed. (2) From January 2003 to January 2011,146 consecutive patients with acute Standford type B aortic dissection underwent stented elephant trunk (SET) surgical approach under deep hypothermia circulatory arrest. The in-hospital mortality rate and complication rate between Standford type A and Standford type B were analysed.Results (1)The in-hospital mortality rate of unilateral Cerebral protection group and bilateral Cerebral protection group was 5.77% and 2.86%,respectively.There was not statistically different between unilateral Cerebral protection group and bilateral Cerebral protection group.The neurological complication rate was 26.92% and 10.00%,respectively. The difference was statistically significant. The in-hospital mortality rate of ascending aorta cannulation group and right subclavian artery intubation are both 4.55%, and the complication rate was 15.9% and 15.2%,respectively. No statistical significance was found between the two groups. (2)The complication rate of acute Standford type B aortic dissection was 14.4% and that of Standford type A aortic dissection was 35.3%,respectively. The difference was statistically significant.Conclusion Stented elephant trunk graft implantation into the descending aorta procedure combined with ascending aorta and total aortic arch replacement under deep hypothermia circulatory arrest has an excellent effect. The techniques of ascending aorta cannulation and modified bilateral antegrade selective cerebral perfusion are safe and advantageous. Stented elephant trunk graft implantation surgical approach for acute Standford type B aortic dissection Have some advantages.