| Objective:To analyze the short-term and mid-term effects of two different surgical methods,Sun’s and stent in-situ fenestration,in the treatment of Stanford A type aortic dissection.Methods:The clinical data of 58 patients with Stanford type A aortic dissection,who were hospitalized and underwent operation form September 2018 to December 2019,were analyzed retrospectively,including 41 males and 17 females,aged from 26 to 69(54.51 ±9.21)years.The Body mass index(BMI)ranged from 16.11～ 37.04(24.43±3.37).Among them,46 cases(79.3%)had hypertension,5 cases(8.6%)had diabetes,4 cases(6.9%)had cerebral infarction,45 cases(77.6%)had mild aortic insufficiency,13 cases(22.4%)had moderate or above aortic insufficiency,11 cases(19.0%)had renal insufficiency and 2 cases(3.4%)had coronary artery involvement.According to the Chinese guidelines,the heart rate was controlled at 60-80 beats /min and the systolic blood pressure was controlled < 120 mm Hg before operation.According to the mode of operation,the patients were divided into two groups: group A = Sun’s group(n = 30)and group B = In-situ fenestration group(n = 28).All the data during hospitalization,such as basic diseases of patients before operation,were compared between the two groups.During operation,such as cardiopulmonary bypass time(Cardiopulmonary bypass time,CPB),aortic clamping time(Aortic cross clamp,ACC),total urine volume and so on.Postoperative urine volume 24 hours after operation,length of stay in intensive care unit,time of mechanical ventilation,days of hospitalization after operation,number of cases of secondary operation and cases of complications.After operation,patients were reexamined by thoracic and abdominal CTA to evaluate the efficacy of Sun’s and In-situ fenestration,and echocardiography was used to evaluate cardiac contractile function and regurgitation after aortic valve replacement.Regular follow-up after discharge included living conditions,cure,complications,death and so on.Based on the data,the clinical effect of stent fenestration in the treatment of aortic arch was analyzed and the experience was summarized.Results:In this study,the time of CBP(183.00 ±35.54min),ACC(128.89±21.35min),intraoperative urine volume(1341.78 ±533.47ml),postoperative24-hour drainage(323.05 ±182.44ml),total drainage(670.53 ±265.3ml)and postoperative hospital stay in the B group were significantly better than those in Sun’s group.There was no significant difference in the length of stay in intensive care unit between In-situ fenestration group(106.46 ±81.86)and Sun’s group(93.82 ±98.63).In Sun’s operation group,the superior mesenteric artery was involved in the preoperative dissection of 2 dead patients within 30 days after operation.There were 2 cases of paraplegia in Sun’s operation group.No internal leakage was found in Sun’s operation group.The follow-up period was 3-19 months.During the follow-up,the surgical efficacy was evaluated by thoracic and abdominal CTA,and cardiac systolic and diastolic function and regurgitation after aortic valve replacement were evaluated by echocardiography.In the B group,1 case was found to have internal leakage by imaging reexamination after operation,and the internal leakage disappeared after 6 months.During the follow-up period,there were no complications such as stroke,coagulation dysfunction,upper limb ischemia,new paraplegia and so on.Conclusion:For acute Stanford type A dissection,the short-term and mid-term safety of In-situ fenestration is no different from that of Sun’s surgery group.Other aspects have certain advantages.Compared with Sun’s surgery,the prognosis still needs long-term observation. |
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