Surgical Treatment Of Stanford Type A Aortic Dissection With Sun’s Procedure-clinical Analysis Of50Cases

Background:Stanford Type A aortic dissection (STAAD) is a life threatening situation which needs emergent surgery. Postoperative early morbidity and mortality rate is still very high in STAAD. Although Frozen Elephant Trunk procedure has shown acceptable clinical results up till now but conflicts are still there about the use of this complex technique in such STAAD patients. The Sun’s procedure is a new surgical treatment for patients with STAAD. This procedure includes complete arch replacement with a tetrafurcated graft and a newly designed/modified open stented frozen elephant trunk graft implantation into the descending aorta (DA), as a treatment choice for wide spread aortic dissections (AD) or aortic aneurysms including ascending aorta (AscA), aortic arch (AA) and descending aorta (DscA). The aim of our study is to clinically analyze50patients who underwent Sun’s procedure with (STAAD) from December2012, to March2014. The principal goal of our study is to analyze factors that influence patient’s outcome and to investigate the role of Sun’s procedure in the future treatment of type A aortic dissection. Materials&Methods:This prospective study was conducted at the Department of Cardiovascular surgery Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P. R. China from December2012to March2014. In this study we included50patients, who underwent the Sun’s procedure. Among these50patients,41(82.0%) were males and9(18.0%) were females. Their mean age was43.7±7years, ranged from32to58years old. Electrocardiography (ECG), Chest X-Ray (CXR), Computed Tomography Angiography (CTA), Echocardiography (Echo) and Magnetic Resonance Imaging (MRI) were used before surgery to validate the diagnosis, to choose an appropriate aortic graft, stented graft, according to the location, type and size of the lesion and assess the degree of dissection. The procedures were carried out under cardiopulmonary bypass with moderate or deep hypothermia(18℃～25℃),brief circulatory arrest and low flow rate selective cerebral perfusion. A Tetrafurcated aortic graft (Maquet) were used to reconstruct the ascending aorta and aortic arch, a stented graft (Cronus) were deployed into descending aorta as standard Sun’s procedure. The HTK solution was used for myocardial protection.The collected preoperative, intraoperative and postoperative data were analyzed by using SPSS19.0through univariate and multivariate analysis of clinical records of50patients who underwent the Sun’s procedure to reveal the relation among preoperative and intraoperative variables and early mortality. Results:During our clinical study3(6%,3/50) patients died early, due to multi-organ failure in2patients (66.6%), infection and renal failure in1(33.3%). Neurologic deficit and spinal cord injury happened in2patients (4%,2/50).(Five significant risk factors for early mortality were identified by univariate and multivariate analysis:preexisting cerebrovascular disease (P=0.00), multiple organ failure (P=0.00), infection (P=0.014), renal failure (P=0.001) and to some extent cross clamp time also>104Minutes (P=0.051).Conclusions:Sun’s procedure showed a lower mortality rate in50patients with STAAD. Patients with preexisting cerebrovascular disease, spinal cord malperfusion, visceral malperfusion and long cardiopulmonary bypass time are at a higher risk of early mortality.