Clinical Analysis Of Surgical Treatment On 15 Cases Of Complex Aortic Dissection

Object: To summarize the clinical characteristics and experiment of surgical treatment of complicated aortic dissection, evaluate the effect of a surgical approach for aortic dissection with a stented elephant trunk procedure.Method: Continuous retrospective analysis from January 2006 to March 2010 of 15 cases of surgical treatment of complex AD patients, male 11 cases, 4 females. Aged 32-69 years, mean age 50.12±12.69 years. Actue or subacute stage in 9 cases. Hypertension in 12 cases (80.00%), long-term history of smoking in 7 cases .Pericardial tamponade and cardiogenic shock with left pleural effusion in 4 cases.Acute renal failure(ARF) in 2 cases.Preoperative transient ischemic attack history or coma in 2 cases. Limb numbness of one side or the side of the pulse weakened or disappeared in 4 cases. Endovascular Repair(EVR) after 6 years in 1 case. Typical Marfan syndrome in 2 cases. Emergency surgery in 8 cases (53.3%). Aortic diameter more than 4cm in 12 cases in preoperative examinations .All patients underwent surgery on cardiopulmonary bypass (CPB).Deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion(ASCP) through right subclavian(axillary)artery or / and left common carotid artery . Total arch replacement+ stented elephant truck technique in 6 cases. Ascending aorta and root replacement + total arch replacement + elephant trunk descending aortic stent surgery in 5 cases: involving mechanical composite graft replacement ( Bentall procedure ) in 2 cases, separate replacement of aortic valve and supracommissural ascending aorta(Wheat procedure)in 2 cases, Valve-preserving partial aortic root remodeling (David II procedure) in 1 cases. Brachiocephalic vascular Island vascularized in 2 cases, four-branch vessel stent in 11 cases, Aortic arch replacement+semi-arch replacement (Bental precedure+ anastomosis of bottom of aortic arch in 3 cases, left subclavian artery proximal anastomosis in 1 case). The postoperative effect of surgery was evaluated by computed tomography (CT).Results:The average CPB time of all patients was196. 8±105.9min;, the aortic cross-clamp time was 98. 8±34.0min, the selective cerebral perfusion time was 26.7±16.9min,the lower body arrest time was 15. 2±8.1min .Hospital mortality in 30 days was 13.8%(2/15).One patient with preoperative acute renal failure ceased treatment after postoperative uncontrollable bleeding .One died of multiple organ failure (MODS) owing to systemic infection 28d after operation. Patients with pulmonary infection postoperatively and respiratory failure in 1 cases . Delayed awakening in 4 cases. Acute renal failure in 2 cases, one was cured by peritoneal dialysis(PD). Transient neurologic dysfunction in 1 case, the whole group had no serious neurological complications. The in-hospital time is 2~35 days, with a mean of(11.2±8.3)days. The follow-up time was 2~35 months (23.6±10.1month) in 13 cases , one patient died of the sudden death , the others remaining good quality of life. Postoperative CT scans showed no obvious false lumen in13 cases in 3~6 months afer surgery.Conclusion:1.. Quick and accurate diagnosis and individualized surgical planning and precise surgical technique is the key to the success of aortic dissection.2. Stent elephant trunk procedure is a safe and effective procedure in surgical treatment of complex aortic dissection.3. Acute renal failure (ARF) is an important factor in cause of perioperative period death.