'Hybrid' Treatment For Aortic Dissections Combining Surgery And Stenting In The Operating Theater

Objective To investigate the clinical experience of stent-graft implantation treatment for the DeBakeyⅠandⅢaortic dissection under direct vision and the application of innominate artery cannulation for cerebral protection.Methods From May 2005 to August 2007,18 AD patients were implanted stent-grafts.There were l4 males and 4 females.The mean age was 55±3 years,ranged from 40 to 62 years.Among the 18 patients,5 cases were DeBakeyⅠ,13 cases were DeBakeyⅢ.The type of the aortic dissection and operative methods were selected according to CT scan before the procedure.Appropriate stent-grafts were selected according the size of the descending aorta during the procedure.The stent-grafts were implanted through the aortic arch under hypothermic circulatory arrest.If dissection did not exist in innominate artery,innominate artery cannulation could be used during cardiopulmonary bypass and selected cerebral perfusion.Results The stent-grafts implantation was successful in all 18 patients.Symptoms disappeared in all patients.There was no hospital mortality.In the follow-up of 3 and 6 months using CT scan,the aortic dissection of the two types were disappeared and thrombosis occurred in the false lumen.Only 1 case had endoleak at the proximal end of the stent.During the follow-up of 3 to 30 months,all patients had no paraplegia,no arm weakness and late death.Conclusion Stent-grafts implantation treatment for the DeBakeyⅠandⅢaortic dissection is an effective way in closing the residual false lumen of the descending aorta and might contribute to the better long term results.And innominate artery cannulation in cardiopulmonary bypass and selected cerebral perfusion is a safe and effective way in the cerebral protection.It can significantly reduce the hospital stay,cost and mortality rate.