| Background:Acute aortic dissection is a high-risk and lethal macrovascular disease that seriously endangers the safety of patients.The mortality of untreated patients with acute Stanford type A aortic dissection has been reported to be approximately 1% to2% per hour after symptom onset,with up to 90% of patients succumbing within 30 days.67% of patients presented with acute Stanford type A aortic dissection,which is the most common in the acute aortic dissection.The main purpose of drug treatment for acute Stanford type A aortic dissection is symptomatic treatment and control the risk factors of the dissection.It is not possible to control the progression of the disease or cure it.At present,the treatment of acute Stanford type A aortic dissection is mainly based on surgical treatment.There are two main methods: the first surgery is ascending aorta or aortic root replacement.Second,the dissection involving the arch requires simultaneous aortic arch or total archreplacement surgery.Acute Stanford type A aortic dissection involving the arch is complicated by surgery and has a high incidence of operative mortality and complications.In recent years,scholars have proposed a new surgical procedure around the reconstruction of the aortic arch.The surgical treatment of the acute Stanford type A aortic dissection which widely involving has become a research hotspot in the field of cardiovascular surgery.The "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" based on the frozen "elephant trunk" surgery has become the recommended technique of most cardiac surgery centers in China.However,this procedure also has the defects of complicated operation,long operation time,more anastomosis of the branch vessels,surgical complications and mortality remain high.With the development of endovascular stent graft technology,branched stent grafts have been widely used in acute Stanford type A aortic dissection.The most representative is the triple-branched stent for the reconstruction of the aortic arch of the acute Stanford type A aortic dissection.This procedure simplifies the operation of the aortic arch,shortens the operation time.However,the complications such as stent displacement and endoleak are prone to occur due to the difference in anatomy of the aortic arch.Based on the above thiple-branched stent,Changhai Hospital of Shanghai and Shenzhen Xianjian Technology Co.Ltd jointly developed a modified double-branched aortic arch stent,which was used in the pre-clinical study of the arch repair of animal model through the early use of this adjustable double-branched stent graft.The study confirmed that the double-branched stent vascular endoscopic with total arch replacement is safe and feasible,and the short-term follow-up results were satisfactory.However,the study of this adjustable double-branched stent graft for open surgery for acute Stanford type A aortic dissection has not been reported in clinical.In this study,the total arch replacement with the double-branched stent was used to treat the acute Stanford type A aortic dissection,and its safety and effectiveness were evaluated.The clinical efficacy was evaluated by comparison with the classic "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" and thetotal arch replacement with the triple-branched stent.Objective:The purpose of this study was to investigate a more optimal surgical treatment for the acute Stanford type A aortic dissection involving the aortic arch:1.To investigate the safety and efficacy of the total arch replacement with the novel double-branched stent for the treatment of acute Stanford type A aortic dissection by the clinical application and efficacy evaluation.2.To evaluate the clinical efficacy of the total arch replacement with the novel double-branched stent for the treatment of acute Stanford type A aortic dissection by comparison with the "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery".3.To evaluate the clinical efficacy of the total arch replacement with the novel double-branched stent for the treatment of acute Stanford type A aortic dissection by comparison with the total arch replacement with the triple-branched stent and to assess the incidence of stent-related complications and further verify its safety and efficacy.Objects and Methods:1.Objects and grouping1)Objects: From October 2013 to February 2015,21 cases of acute Standford type A aortic dissection were collected and treated with the total arch replacement with the novel double-branched stent in our hospital.186 cases of acute Stanford type A aortic dissection were treated with the "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" during the same period.23 cases of acute Stanford type A aortic dissection were treated the total arch replacement with the triple-branched stent.2)Grouping:(1)To evaluate the clinical efficacy of the total arch replacement with the novel double-branched stent group and the "total aortic arch replacement with four branchprosthesis vessel and elephant trunk suegery" treatment group.(2)To evaluate the clinical efficacy of the total arch replacement with the novel double-branched stent group and the total arch replacement with the triple-branched stent.2.Methods:1)The clinical evaluation of the effectiveness of the total arch replacement with the novel double-branched stent includes: successful stent placement,the total operation time,the circulatory arrest time,the cardiopulmonary bypass time,the aortic crossclamp time,intraoperative blood transfusion and hemorrhage,stent displacement,endoleak incidence,secondary surgery,etc.The safety evaluation mainly refers to the incidence of major adverse events(including death,paraplegia,brain complications,etc.)within 12 months.2)The clinical evaluation of the effectiveness of the total arch replacement with the novel double-branched stent group by comparison with the "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" group included: the total operation time,the aortic crossclamp time,intraoperative blood loss and blood transfusion,patency after aortic remodeling,false cavity thrombosis rate,and surgery-related complications and mortality during hospitalization and follow-up.3)The clinical evaluation of the effectiveness of the total arch replacement with the novel double-branched stent group by comparison with the total arch replacement with the triple-branched stent group included: successful stent placement,the total operation time,the cardiopulmonary bypass time,the aortic crossclamp time,intraoperative blood loss and blood transfusion,whether the stent has displacement or endoleak,false cavity thrombosis rate,and surgery-related complications and mortality during hospitalization and follow-up.4)Statistical analysis: All data were statistically analyzed using SPSS 20.0statistical software.The count data is described by composition ratio,and themeasurement data is described by mean,standard deviation,maximum value and minimum value.The paired t test was used to compare the normal distribution of the measurement data sets.Surgery-related complications and mortality were compared between the two groups using the ?2 test or Fisher's exact probability test.Results:1.The novel double-branched stent were successfully placed into the true aorta of the descending aorta,aortic arch,left subclavian artery and left common carotid artery in 21 patients with the total arch replacement with the novel double-branched stent group.The mean time of cardiopulmonary bypass was 210.2 ± 32.4 min,the mean time of aortic occlusion was 94.9 ± 18.0 min,and the mean time of selective cerebral perfusion and deep hypothermic circulatory arrest was 27.0 ± 10.4 min.The hospital mortality rate was 4.8%.The mean follow-up time was 38.2 ± 12.5 month.No serious complications associated with stents such as endoleaks and stent displacement during follow-up.2.The preoperative clinical data of the total arch replacement with the novel double-branched stent group and the "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" treatment group were not statistically different except for age(P<0.05).The total operation time,intraoperative blood transfusion and hemorrhage,postoperative disturbance of consciousness,coma,paraplegia,lower extremity paralysis,renal insufficiency and mortality were significant lower in the total arch replacement with the novel double-branched stent group than the "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" group(P<0.05)..3.The preoperative clinical data of the total arch replacement with the novel double-branched stent group and the total arch replacement with the triple-branched stent group were not statistically different.The total operation time,the cardiopulmonary bypass time,the aortic crossclamp time,intraoperative blood transfusion and hemorrhage were higher in the total arch replacement with the noveldouble-branched stent group than that of the total arch replacement with the triple-branched stent group.Howere,the incidence of postoperative endoleak and stent displacement was significantly lower than that of the triple-branched stent group.Conclusions:1.This study demonstrates that the total arch replacement with the novel double-branched stent is safe and effective that was simply performed.It can be used as a new method for the selection of acute Stanford type A aortic dissection with total arch repair.2.Compared with the classic "total aortic arch replacement with four branch prosthesis vessel and elephant trunk suegery" treatment of acute Stanford type A aortic dissection,the total arch replacement with the novel double-branched stent treatment significantly shortened the operation time,reduced intraoperative blood transfusion and hemorrhage,and postoperative complications and mortality were relatively reduced.3.Compared with the total arch replacement with three-branched stent for the treatment of acute Stanford type A aortic dissection,the incidence of stent displacement and endoleak after the total arch replacement with the novel double-branched stent was significantly reduced. |
PDF Full Text Request