| Objective Acute type A aortic dissection is one of the most dangerous emergencies in cardiac surgery and the surgical treatment is a huge challenge.With the progress of medical technology and aging of the population of the society,more elderly patients with aortic dissection also increase the risk of surgical treatment.Hybrid aortic arch repair(HAAR)provides a new choice for these high-risk patients.By analyzing the early-and mid-term clinical results of type ? hybrid aortic arch repair for the treatment of acute type A aortic dissection(ATAAD),the efficacy of hybridization technique in the application of acute type A aortic dissection was evaluated systematically.Methods We retrospectively studied the records of patients with ATAAD who were admitted to the Beijing Fuwai hospital between January 2016 and December 2018.504 patients were included for analysis(383 men and 121 women;mean age,50.0±11.7 years,),the rate of hypertension was 76%,the average time of onset to operation was(69.5±40)hours.During this period,110 continuous patients underwent hybrid aortic arch repair(HAAR)without deep hypothermic circulatory arrest,the landing zone of stent was located in ascending aorta(Zone 0);394 consecutive patients with ATAAD involving the aortic arch received traditional total aortic arch replacement with frozen elephant trunk(FET).A propensity score-matching analysis was applied to adjust for age and gender.The preoperative,perioperative and postoperative data in the HAAR group and FET group were compared.Results For all 504 patients,male patients accounted for 76%.There were 24 cases of early death(4.8%),20 cases of stroke(4%)and 7 cases of paralysis(1.4%).HAAR group showed more age(62.1±6.8 vs 46.6±10.4 years,p<0.001),hypertension(87.3%vs 77.4%,p=0.033),coronary artery disease(13.6%vs 6.1,p=0.016)and chronic obstructive pulmonary diseases(12.7%vs 3.6%,p=0.001)than the FET group.HAAR group showed shorter cardiopulmonary bypass time(143.7±53.7 vs 175.3±52.7 min,p<0.001)and aortic cross-clamping time(78.5±33.6 vs 106.9±37.8 min,p<0.001)than the FET group.Between the two groups there was no significant difference in operative mortality,rate of reoperation,and late mortality.Follow-up period ranged from 2 to 43 months,averaged 22.6±11.1 months.During folloe-up period,there were 5 cases of death(4.9%)and 3 cases of reoperation(3.1%)in HAAR group,10 cases of death(2.7%)and 11 cases of reoperation(3.3%)in FET group.3 patients lost follow-up because of not been rechecked in the outpatient department or the phone was not connected.Conclusions This single-stage hybrid arch procedure offers an alternative approach to acute type A dissection and associated with acceptable early and midterm major morbidity and mortality in old-age patients.Future further researches are required to confirm the long-term outcomes.Objective By analyzing the clinical effects of type II hybrid aortic arch repair for the treatment of type A aortic dissection in different age groups,the efficacy of hybridization technique in the application of type A aortic dissection was evaluated systematically.Methods We retrospectively studied the records of patients with type A aortic dissection who were admitted to the Beijing Fuwai hospital between January 2016 and December 2018.During this period,126 continuous patients underwent hybrid aortic arch repair without deep hypothermic circulatory arrest,the landing zone of stent was located in ascending aorta(Zone 0);According to the age of 60 years,it can be divided into the elderly group(?60 years old)and the non-elderly group(<60 years old).The preoperative,perioperative and postoperative data in the two group were compared.A total of 194 stents were implanted in 126 patients,the average dimeter was 33.6±1.8mm,the average length was 199±6.7mm.Results There were 6 cases of early death(4.8%),3 cases of stroke(2.4%)and 2 cases of paralysis(1.6%).Elderly group showed higher age(62.1±6.8 vs 46.6±10.4 years,p<0.001)than the non-elderly group and no significant difference in other preoperative baseline data between the two groups.Non-elderly group showed shorter mechanical ventilation time(31.93±41.67 vs 61.01±89.17 h,p=0.0043)and ICU stay time(77.8±51.42 vs 143.07±114.4 min,p<0.001)than the Elderly group.Between the two groups there was no signifi cant difference in operative mortality,rate of reoperation,and late mortality.Follow-up period ranged from 1 to 43 months,averaged 22.6±10.8 months,with 3 patients lost follow-up.There were 104 cases of complete thrombus formation of false lumen in stent(82.5%)and endoleak was reported in 11 patients(9.2%).Conclusions This single-stage hybrid arch procedure offers an alternative approach to acute A dissection and associated with acceptable early and midterm major morbidity.Non-elderly group was corresponded to the Elderly group in early treatment effect of the and better than Elderly group in mid-outcome.Future randomized controlled trial and long-term follow-up studies of large sample are needed.Objective By analyzing the early results of randomized controlled trial of type ? hybrid aortic arch repair(HAAR)for the treatment of acute type A aortic dissection(ATAAD),the efficacy of hybridization technique in the application of acute type A aortic dissection was evaluated systematically.Methods We evaluated 60 patients(age range of 50 to 59)with ATAAD who were admitted to the Beijing Fuwai hospital between January 2018 and January 2020.During this period,30 continuous patients underwent hybrid aortic arch repair(HAAR)without deep hypothermic circulatory arrest,the landing zone of stent was located in ascending aorta(Zone 0);30 consecutive patients with ATAAD involving the aortic arch received traditional total aortic arch replacement with frozen elephant trunk(FET).The preoperative,perioperative and postoperative data in the HAAR group and FET group were compared.Follow-up period ranged from 1 to 25 months,averaged 8.2±6.2 months,with no lost follow-up.Results The average age of all patients was(54.7±3.0)years,male patients accounted for 66.7%,the average time of onset to operation was(84.6±143.9)hours.There were 6 cases of early death(10%),3 cases of stroke(5%)and 2 cases of paralysis(3.3%).HAAR group showed more age(55.7±2.9 age vs 53.8±2.9 age,p=0.014),onset to operation hours(132.9±176.7 h vs 36.2±30.5 h,p=0.005)than the FET group.HAAR group showed shorter cardiopulmonary bypass time(143.7±53.7 vs 175.3±52.7 min,p<0.001),aortic cross-clamping time(78.5±33.6 vs 106.9±37.8 min,p<0.001)time in surgery(7.4±1.9 vs 8.8±3.1 hour,p=0.038),and blood loss(826.8±260.1 vs 1083.3±506.5 ml,p=0.017)than the FET group.HAAR group showed lower early mortality(6.7%vs 13.3,p=0.667)than the FET group.Between the two groups there was no significant difference in postoperative complication.Conclusions This single-stage hybrid arch procedure offers an alternative approach to acute type A dissection and associated with acceptable early major morbidity and mortality in old-age patients.Future further researches are required to confirm the large and long-term outcomes. |
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