Application Of Home-made Three-branch Aortic Graft In Sun’s Procedure

Objective:To explore the feasibility of the application of the first-generation and second-generation home-made three-branch aortic graft in Sun’s procedure,and to to provide an alternative and perfect implant material for the surgical treatment of acute A-type aortic dissectionMethods:In this study,60 patients with acute type A aortic dissection admitted to our hospital from January 2018 to December 2020 who underwent Sun’s procedure were selected.According to the type of artificial blood vessels used,they were divided into three groups: four-branch aortic graft group(n=31),first-generation home-made three-branch aortic graft group(n=14),and second-generation home-made three-branch aortic graft group(n=15).Collect patients with preoperative general data.Preoperative complications were determined according to cardiac ultrasound,CTA of thoracic and abdominal aorta,and physical examination of corresponding signs.The total duration of operation,cardiopulmonary bypass time,aortic crossclamp time,total cerebral protection time,intraoperative transfusion requirement,etc.,were collected in the 3 groups during the operation.The postoperative recovery and complications of the 3 groups were observed.Follow-up was conducted to count the relevant indexes of cardiac color ultrasound,thoracic and abdominal aortic CTA and the survival of the patients through telephone,network and outpatient service.SPSS 25.0 software was used for statistical processing of the data in this study,and the intraoperative conditions,use of blood products,postoperative recovery,complications and follow-up status of different groups were analyzed and compared.P≤0.05 was considered to be statistically significant.Results:There were no significant differences in gender,age,height,weight,history of hypertension,history of diabetes,onset to operation time,and systolic blood pressure at admission among the 3 groups(P>0.05),but there were significant differences in smoking history(P≤0.05).Second-generation home-made three-branch aortic graft group had less smoking history.Three groups of patients in preoperative without merge abdominal viscera perfusion defects,in the presence of marfan syndrome,medical history,history of presence of heart surgery,differences of no statistical significance(P > 0.05),cause aortic dissection involving the aortic valve of moderately severe reflux,coronary artery involvement,pericardial effusion,preoperative cerebral infarction,severe lower limb artery involvement,myocardial enzymes,an abnormal renal function,liver function abnormal interlining related complications such as no significant difference(P >0.05).All patients in the 3 groups received Sun’s procedure,and there were no significant differences in total operative time,cardiopulmonary bypass time,aortic crossclamp time,total cerebral protection time,intraoperative transfusion requirement,intraoperative urine volume,and intraoperative usage of blood products(plasma,red blood cells,platelets,cryoprecipitation)among the 3 groups(P>0.05).There were no significant differences among the 3 groups in drainage volume 24 hours after surgery,indwelling time of drainage tube,mechanical ventilation time,ICU retention time,postoperative transfusion of blood products(plasma,red blood cells),and total hospital stay(P>0.05).No postoperative death occurred in all patients,and no secondary thoracotomy for hemostasis occurred after surgery.There were no significant differences in postoperative complications such as postoperative hemodialysis,transient neurological symptoms,permanent neurological symptoms,paraplegia,pulmonary infection,sepsis,postoperative hoarse,and perioperative death(P>0.05).After postoperative follow-up,the3-month survival rates of each group were 96.6%,92.3% and 100%,respectively,without statistical significance(P>0.05).There was no new hairpin layer,no progress of aortic dissection,no displacement of elephant trunk stent,no leakage of arch vessels,no formation of pseudoaneurysm,and no other complications.Conclusion:The home-made three-branch aortic graft can be used in Sun’s Procedure when commercial four-branch aortic graft group is lacking.When the size of the neck branch vessels does not match the commercial four-branch aortic graft,the home-made three-branch aortic graft is more convenient for vascular anastomosis,better for the reconstruction of partial branch vessels of the arch,and less bleeding during operation.When the aortic arch has anatomic variation,the home-made three-branch aortic graft has unique advantages in reconstruction of physiological structure and maintenance of neck hemodynamics,which has certain clinical significance.