Effects Of Different Treatments On The Prognosis And Aortic Arch Morphology Of Type B Aortic Dissection

Objective: To investigate the effect of different treatment methods on the prognosis,angle and curvature of aortic arch of Standford type B aortic dissecting aneurysm.Methods: From January 2016 to December 2018,63 cases of thoracic aortic dissection aneurysm,thoracic aortic rupture and other aortic dilatation diseases admitted to the department of cardiac surgery of Northern Jiangsu People’s Hospital were counted and treated with thoracic aortic stent.The treatments for aortic lesions with left subclavian artery openings less than 15 mm include artery bypass grafting(hybridization)in 7 cases,direct closure of left subclavian artery openings in 9 cases,and chimney stenting in 13 cases.The rest 34 cases with the distance between aortic lesions and the left subclavian artery greater than 15 mm were treated by saving the left subclavian.All cases were treated with conservative medical treatment before surgery.Then,the coated stents were grafted within thoracic aortic and different methods were adopted to tackle with the left subclavian artery or left subclavian artery with insufficient anchoring area.And after the surgery,all cases were treated by symptoms.Then the clinical data of patients were collected and analyzed retrospectively,and the prognosis of patients with different treatment methods was statistically analyzed.According to the preoperative and postoperative imaging data of the patients,61 patients with incomplete preoperative and postoperative aortic CTA cases were excluded,and then the angle and curvature of the aortic arch before and after surgery were measured and analyzed using IBM SPSS software.Paired t-test was used to analyze the paired data before and after operation,and the influences of angle and curvature change were analyzed by univariate and multivariate analyses.Results: All operations were successful for the 64 cases.In the cases involving the left subclavian artery,the survival rate,average postoperative hospital stay and complications in the occlusion group were superior to those in the hybrid group and the chimney group.For the angle and curvature data of the aortic arch before and after surgery,paired data were obtained by paired t-test analysis before and after surgery,and p was all less than 0.05,so the difference was statistically significant.Univariate and multivariate analyses of the influencing factors of angle and curvature changes showed that the p values were all greater than 0.05,showing no statistical difference.Surgical methods and stent materials are not the factors influencing the changes of Angle and curvature.Conclusion: 1.Under the condition of strict control of indications,the closure of left subclavian artery opening is better in hybrid surgery,and the chimney stent technique has better prognosis.2.The placement of coated stent has certain effects on the angle and curvature changes of the aortic arch.3.The changes of angle and curvature of the aortic arch bear no obvious relationship with the surgical method and stent materials,which may be related to the shape of the aortic arch itself and the depth of the aortic arch implanted with the stent.