Treatment For Acute Type A Aortic Dissection Using Implantation Of Triple－branched Aortic Arch Covered Stent Under Deep Hypothermic Circulatory Arrest

Objectives: To summary the clinical experience of Treatment for acutetype A aortic dissection using implantation of triple－branchedaortic arch covered stent under deep hypothermic circulatory arrest.Methods: Between February2010and October2011，50well selectedpatients with Stanford type A aortic dissection Underwent open threebranches aortic arch covered stent graft implantation for archreconstruction．When core cooling to20℃nasopharyngeal temperature，deep hypothermic-circulatory arrested，Selected cerebra perfusion，andthe ascending aorta was transected．three branches aortic arch coveredstent graft was inserted into the true lumen of the arch and descendingaorta．The transected stump of the ascending aorta was reconstructed byend－to－end anastomosis of inner proximal stent graft.Result: There were no deaths during operating. Three branches aortic archcovered stent graft was technically successful in all patients．The meancardiopulmonary bypass time，aortic cross clamp time，circulatoryarrested time，average selective cerebral perfusion time were(192．30±32．56)min，(85．88±18．65)min，(8．12±5．59)min，(35．8±6．78)min，respectively． Drainage volume of pericardial effusion and pleuraleffusion after surgery was（636.62±438.61ml）.Three patients died during hospitalization, the causes of death were acute renal failure, severe lung infection and rupture of abdominalaortic dissection. The47patients were follow-up in outpatient regularly,with no deaths and reoperation cases, no stent-related complications.Review of abdominal aortic CTA, we find that the trunk bracket vascularand the branch were all unobstructed well, without distorting, andthrombosis in the false lumen between aortic arch and thoracic aortic.Conclusions: Three branches aortic arch covered stent graft underdeep hypothermic circulatory arrest simplified the aortic arch operation，and lower operative risk in treatment of Stanford type A aorticdissection，but the number of surgical cases is still small, its long termresults need advanced observation．...