Triple-Branched Stent Graft Implantation Of Vascular Surgery And Aortic Valvuloplasty In The Treatment Of Stanford-Type A Aortic Dissection

【Objective】To summary the clinical experience of triple-branched stent graft implantation of vascular surgery and aortic valvuloplasty in the treatment of Stanford type A aortic dissection【Methods】Between July 2009 and March 2011, 45patients with acute Stanford type A aortic dissection underwent extensive primary repair of the thoracic aorta by means of ascending aorta replacement combined with triple-branched stent graft ,the operations were all performed under general anesthesia, were carried out under deephypothermia with circulatory arrest and selected cerebral perfusion. artificial blood vessel replacement and total arch grafting with triple-branched stent graft was carried out in 11 cases, aortic valvuloplasty+ artificial blood vessel replacement and+total arch grafting with triple-branched stent graft was carried out in 28 cases .BENTALL and total arch grafting with triple-branched stent graft was carried out in 5 cases; BENTALL + total arch grafting with triple-branched stent graft +coronary artery bypass was carried out in 1 case..【Results】No patient died in surgerical operation.Mean cardiopulmonary bypass time was 195.65±36.95 minutes(range 128 to 310 minutes).Mean aortic cross-clamp time was 89.05±18.06 minutes(range 62 to 150 minutes ).Mean low-flow cerebral perfusion time was 30.75±6.64 minutes(range 15 to 40 minutes),and mean circulatory arrest time was 4.86±2.18 minutes(range 2 to 11 minutes);there were no significant aortic valve regurgitation by echocardiography after the operation .Three patients died during hospitalization, one died because of rupture of abdominal aortic dissection on the first day after operation ,one died because of renal failure, one died because of Severe pulmonary infection .there were no postoperative bleeding and re-thoracotomy cases of permanent brain damage. Currently 42 patients on regular follow-up, no death and the need for reoperation cases.【Conclusions】Artificial blood vessel replacement and total arch grafting with triple-branched stent graft is a safe way.Aortic valvuloplasty by means of Endovascular aortic patch can increase the rate of succession and effection。Deep hypothermic circulatory arrest selective cerebral perfusion can be effective in preventing complications of the nervous system..