Surgical Treatment For Acute Stanford A Type Aortic Dissection And An Analysis Of Early Postoperative Complications

ObjectiveTo summarize the experience of surgical treatment for patients with acute Stanford A type aortic dissection,explore the surgical outcomes and the appropriate surgical strategies,analyze the incidence,treatment and recovery,risk factors of early postoperative complications.MethodsThe clinical data of 61 patients admitted to Tianjin chest hospital from January 2014 to December 2016 was retrospectively reviewed,with the mean age of 50.69±14.50years(14-79).43 cases were male and 18 cases were female.Arch surgeries were performed for the condition of arch involvement in 50 cases(Arch Group),including 47 sun’s procedure and 3 hemi-arch replacement of right side.For the condition of no arch involvement,only root and ascending aortic surgeries were taken for 11 patients(Non-arch Group).Analyzed baseline data,preoperative laboratory examination,surgical parameters,postoperative laboratory examination and early postoperative complications by use of SPSS 20.0 statistical software.According to with or without early postoperative complications,60 cases were divided into with-complication group(29 cases)and without-complication group(31cases).Chi-square test,t test or non-parametric test were applied to analyze the risk factors of early postoperative complications.ResultsIn total,53 cases were cured,with a cure rate of 86.89%.1 case died in operation,2 cases died postoperatively,5 cases abandoned treatment and discharged.The cure rate of Sun’s procedure was 87.23%,and the death rate was 4.26%.Mean extracorporeal circulation time(Arch vs Non-arch surgeries,174.22±42.07 min vs 106.00±24.22 min,p<0.05);aortic clamping time(Arch vs Non-arch surgeries,101.60±19.94 min vs 77.20±15.52 min,p<0.05);median operative blood loss(Arch vs Non-arch surgeries,1400(1030-2207.5)ml vs 900(700-1200)ml,p<0.05);median ICU stay time(Arch vs Non-arch surgeries,6.00(4.00-11.00)d vs 3.00(2.00-4.00)d,p<0.05).No significant difference was found between two groups for early postoperative complications(p>0.05).Early postoperative complications included 21 cases of neurologic complications,9 cases of respiratory insufficiency,9 cases of acute renal failure,4 cases of acute hepatic damage,2 cases of low cardiac output syndrome and 1 case of cardiac tamponade,1 case of re-operation for bleeding,1 case of multiple organ failure(MOF),7 cases of pleural effusion,8 cases of pulmonary infection,1 case of upper gastrointestinal bleeding,1 case of wound infection.Risk factors for early postoperative complications are: hypertention history,coronary artery involvement,obesity,surgery and anesthesia time,extracorporeal circulation ≥ 200 min.Conclusion1.The surgical treatment for acute Stanford A type aortic dissection is effective and reliable,with satisfactory short-time results;Sun’s procedure is the safe and credible approach for type A aortic dissection with complexed arch involvement,with the cure rate of 87.23%,and death rate of 4.26%.2.Arch surgery has longer operation time,more intraoperative blood loss,slower recovery than Non-arch surgery,however can not increase early postoperative complication rate(P>0.05).3.Most common early postoperative complications were neurologic complications,acute renal failure,respiratory insufficiency;and for patients with hypertension history,obesity,coronary artery involvement,or longer operation time,corresponding measures should be taken more actively to control the occurrence and development of early postoperative complications.