Surgical Treatment Of51Patients With Aortic Dissection

Objective: To explore the experience of surgical treatment of Stanford type A aorticdissection. Methods: A retrospective analysis of diagnosis and treatment in ourdepartment that51cases of Stanford type A aortic dissection in patients with clinical datafrom January2007to December2011.Among male42cases (82.35%) and9females(17.65%),age18~65years old, average41.7±8.63years old. The Debakey I35cases,16cases of type II,29cases of acute, subacute15cases,7cases of chronic. There are27cases of Bentall surgery, among that4cases of concomitant coronary artery bypassgrafting (CABG surgery)(saphenous vein),4cases of mitral valve replacement (MVR),the right half of arch replacement was performed in two cases, simple ascending aorticreplacement was performed in8cases, ascending aorta replacement+aortic archreplacement+descending thoracic aortic stent implantation in12cases, aortic sinusangioplasty+aortic arch replacement+descending thoracic aortic stent implantation of fourcases, involving arch surgery using deep hypothermic circulatory arrest+selective antegrade cerebral perfusion or retrograde perfusion brain protection upper right superior venacava, the rest are regular establishment of cardiopulmonary bypass. Results:9cases(17.65%) postoperative deaths, which died of low cardiac output syndrome3cases,2cases of multiple organ dysfunction syndrome (MODS), renal failure in3cases, after twomonths of severe infection complicated by respiratory failure to give up treatment to thefamilies of cases. Anastomotic bleeding the second thoracotomy to stop bleeding of twocases. Cardiopulmonary bypass time was60~555min, an average of160.58±14.46min;heart clamping time45~177min (94.32±4.88) min; auxiliary time10~470min, an averageof57.24±14.12min. Postoperative hospital stay was5to41days, an average of24.87±1.49days. ICU time261h, an average of51.14±13.84h, intubation time0.5~230h, anaverage of43.51±13.12h. Conclusion: Surgery is quick and accurate diagnosis of theStanford A dissection choice and efficacy of treatment after admission, and to give areasonable preoperative treatment is a prerequisite to ensure that the surgery went well and completed. Sandwich break and involving the range of different surgical methods,prevention of blood loss, shortened cardiopulmonary bypass time is the key to successfuloperation. Four. Deep hypothermic circulatory arrest combined with selective cerebralperfusion is an effective method of cerebral protection, help prevent brain injury andneurologic symptoms occur.