| Objective:By analyzing the application of composite hybrid surgery and Sun’s surgery in acute type A aortic dissection,comparing the advantages and disadvantages of the two procedures,evaluating the short-term and long-term surgical efficacy,and providing a new direction of exploration for the treatment of acute type A aortic dissection.And further investigate the impact of the deviation of the angle between the end of the stent and the small curved side of the vascular wall on distal aortic remodeling.Methods:From December 2018 to December 2021,the clinical data of patients with acute Stanford type A aortic dissection who had undergone composite hybrid surgery or Sun’s surgery in Cardiac Vascular Surgery of the the Dongfang Hospital affiliated to Tongji University were retrospectively analyzed.23 patients were selected,including 11 patients undergoing composite hybrid surgery and 12 patients undergoing Sun’s surgery.All patients were diagnosed through cardiac color Doppler ultrasound and CTA examination of the thoracoabdominal aorta.Compare the preoperative general data(gender,age,BMI,etc.),intraoperative data(total surgical time,circulatory arrest time,aortic clamp time,and extracorporeal circulation time,etc.),and postoperative data(ICU retention time,postoperative short-term mortality rate,and complications,etc.)of the two groups of patients,and regularly follow up the CTA examination of the thoracoabdominal aorta to evaluate related complications.Measure the changes in the proportion of true aortic lumen and the degree of thrombus in the distal false aortic lumen at the bifurcation of the pulmonary artery,aortic sinus and diaphragmatic plane.Analyze the angle between the end of the stent and the small curved side of the vascular wall to preliminarily explore the impact of its deviation on distal aortic remodeling.Results:(1)Preoperative general data: The proportion of males,the proportion of preoperative combined hypertension,and BMI were high in both groups(hybrid group vs Sun group,male 90.9% vs 91.7%,concomitant hypertension 81.8% vs 75.0%,BMI index 28.35 ±3.28 kg/㎡ vs 26.76 ± 3.47 kg/㎡),and there was no statistically significant difference between the groups.(2)Intraoperative data: The hybrid group avoided circulatory arrest(0 min vs 18.42± 13.24 min),with a statistically significant difference(P<0.05).The total surgical time in the hybrid group was longer than that in Sun’s group(due to the need for intervention operations after surgical procedures in the hybrid group).The total surgical time was described by the median(quartile interval)and the result was(665(568,720)min vs 535(460,618.5)min),with a statistical difference(P<0.05).The aortic occlusion time,the amount of intraoperative plasma transfusion,and the number of patients requiring platelet transfusion were less in the hybrid group than in the Sun group,but there was no statistical difference.Other indexes,such as extracorporeal circulation time and intraoperative infusion of cryoprecipitate were similar,with no statistical differences.(3)Postoperative data: The short-term mortality rate(2 weeks)and the number of patients with acute kidney injury requiring dialysis treatment in the hybrid group were lower than those in the Sun group(hybrid group vs Sun group,0% vs 8.3%,0% vs 16.7%),but there was no statistical difference.The incidence of postoperative neurological dysfunction in the hybrid group was less than that in the Sun group(9.1% vs 58.3%),with a statistical difference(P<0.05).The albumin values of the hybrid group before discharge were higher than those of the Sun group(35.32 ± 2.69 g/L vs 31.35 ± 4.08 g/L),with a statistical difference(P<0.05).The 24 hours postoperative drainage volume in the hybrid group was lower than that in the Sun group,and the number of patients with abnormal liver and kidney function were higher in the hybrid group than in the Sun group.Other indicators such as whether there was blood transfusion after surgery,reoperation,ICU retention time,and postoperative hospitalization time were similar,with no statistical difference.(4)Imaging follow-up: According to the expert consensus on the follow-up of aortic dissection,and due to the significant impact of the remodeling of the distal true lumen and thrombosis of the false lumen on the long-term efficacy and risk of reoperation of patients,three planes were selected for this study,according to the proximal and distal,namely the bifurcation of the pulmonary artery,the aortic sinus,and the diaphragmatic plane as the measurement planes.The results showed that at the diaphragmatic plane,the proportion of true lumen in the hybrid group was higher than that in the Sun group at follow-up of 3 months,6 months,and 1 year,but there was no statistical significance.There were no statistically significant differences in the proportion of true lumen,the process of complete thrombosis of the false lumen,and incidence of endoleaks after surgery in the bifurcation of the pulmonary artery and aortic sinus planes.Due to the degree of coverage of the distal end of the stent being related to the remodeling process of the true lumen,we reclassified all patients into two groups based on whether the deviation between the end of the stent and the small curved vascular wall was within 10 °.The results showed that patients with deviation within 10 ° were followed up for 3 months,6 months,and 1 year,with a higher proportion of true lumens in the diaphragm plane and a higher degree of complete thrombosis of false lumens at all three levels compared to the other group.At 3 months of follow-up,there was a statistical difference in the proportion of true lumens in the diaphragm plane(P<0.05),but the rest were not statistically different.Conclusion:1.Both the hybrid surgery group and the Sun’s surgery group have good therapeutic effects in acute Stanford type A aortic dissection.2.The hybrid surgery group avoided deep hypothermic circulatory arrest,resulting in a longer total surgical time and fewer early postoperative neurological complications,with statistical differences.3.The intraoperative aortic occlusion time,the amount of intraoperative plasma transfusion,the number of patients requiring platelet transfusion,the short-term mortality rate,the number of patients with acute kidney injury requiring dialysis treatment,the 24 hours postoperative drainage volume in the hybrid group were all lower than those in the Sun group.At the follow-up of the diaphragm plane,the proportion of true lumen was higher than that in the Sun group,but there was no statistical difference.4.The angle deviation of within 10 ° between the end of the stent and the small curved vascular wall is beneficial for distal aortic true lumen remodeling. |
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