Sun’s Procedure For Acute Standford Type A Aortic Dissection An Analysis Of The Early Postoperative Complications And Risk Factors

Objective: By analyzing the clinical records of patients who had undergone theSun’s Procedure (total arch replacement combined with stented elephant trunkimplantation) with acute Standford type A aortic dissection, to study the incidenceof early postoperative complications and find out the risk factors, for the sakeof improving the long term outcomes of the surgery.Methods: A retrospective analysis of59patients’clinical records who hadundergone the Sun’s Procedure with acute Standford type A aortic dissection（thosewho had preoperative complications were excluded) from December2009to December2013in the First Hospital of Jilin University, including their age, gender,BMI(=body mass index), BSA(=body surface area), subtype, risk factors for thedisease, operation time, cardiopulmonary bypass（=CPB） time, cross clamp time,selective cerebral perfusion and deep hypothermic circulatory arrest time, parallelcardiopulmonary bypass time, the average oxygenation index during the24hours afterthe surgery, blood transfusion volume during the surgery and24hours later, wakinghours, removing time of the intra-tracheal tube, ICU(=intensive care unit) time,complications after the procedure, discharge time et al. The59patients areclassified into two groups, the complication group and the non-complication group.Chi square test, t test were applied to analyze the association among the basiccharacteristic, operation events and early postoperative complications by using thesoftware SPSS19.0.Results: Fifty-nine patients were enrolled in this research, the male/femaleratio was close to4to1.The average age are47.87year old and there is merelydifference between the incidence of male or female in statistical significance. Forty of them suffered from postoperative complications in the early stage with anincidence67.8%.Nine patients（15.3%）died in-hospital, only1(1.7%) case died ofthe distal anastomosis hemorrhage during the surgery, the others(13.6%) were alldied of early postoperative complications. Univariate predictors for earlypostoperative complications include emergency operation, time of the surgeryrelated events, high blood pressure and smoking history.Conclusion:1.Sun’s procedure is an effective way to treat acute Standford typeA aortic dissection, however, the incidence of the various postoperativecomplications in the early stage are still high. The nervous system relatedcomplications, acute renal failure as well as the respiratory and circulatoryfailure are the main causes of death in hospital.2.Hypoxemia is the most ordinarytype of complications during the early postoperative period. Most of them can becured by adjusting the mechanical ventilation parameters or the medicine treatment.Reduce the machine blood transfusion volume during the surgery or24hours latermay contribute to reduce its occurrence and progression.3. Early postoperativecomplications are closely related to the extracorporeal circulation events.Improving the proficiency in operation, shortening the operation time, especiallythe hypothermic circulatory arrest and selected cerebral perfusion time may helpto improve the outcome of the surgery.4. Risk factors for postoperativecomplications are various. In order to guide further treatment and improvepatients’ prognosis, maybe we can make a rating scale according to the influenceof the risk factors for the postoperative complications, calculate the total scoreand then make a prediction for them.