A Modified Method Of Shaping Proximal End Of Ascending Aorta In Type A Aortic Dissection Treatment

Objective:To describe surgical method and technical details of a modified method ofshaping proximal ascending aorta stump and discuss the outcomes in treating type Aaortic dissection patients.Material and method:A total of153patients with type A aortic dissection accepted modified method ofshaping proximal ascending aorta stump at2nd hospital of Jilin University betweenOctober2011and December2014.An analysis of proximal ascending aorta diametersand aortic valve regurgitation was done in these patients using CTA andechocardiography preoperative, before discharge and at6-months follow uprespectively. Patients with medium or above aortic valve regurgitation who acceptedmodified proximal ascending aorta shaping were studied differently according toconcomitant aortic valve replacement or not. We also made analysis of operative time.cardio-pulomonary bypass time. ascending aorta clamping time. cardiac arrest time.blood transfusion. postoperative drainage. postoperative conscious recovery time aswell as time of ventilator use. ICU stay and in-hospital hour. We also evaluatedcomplications such as bleeding.residual false lumen. psuedoaneurysms and ect.Result:144patients gained full recovery before discharge while9patients died, with amortality of5.9%.No patients died intraoperatively. No lining of aortic adventitia orright atrium drainage was performed during operation. No uncontrolled bleedingleading a second CPB or no postoperative massive bleeding leading to a secondthoracotomy happened among these patients. CPB time.ascending clamping time andcardiac arrest time wasn’t prolonged significantly. Time of operation, intraoperativeblood transfusion was significantly reduced. The amount of patients had CTA andechocardiography before discharge and6-month follow up was respectively133and102.Ascending diameters and aortic valve regurgation of the patients were within the normal range. No remaining false lumen and pseudoaneurysms happened. Theascending diameters and aortic valve regurgation of patients with preoperative aorticvalve regurgation who accepted only shaping of proximal ascending aorta were alsowithin the normal range and had no difference from patients who performed aorticvalve replacemtent. No patients died during6month follow up. All the patients aresatisfied with their life abilities.Conclusion:The modified method of shaping proximal ascending aorta stump was technicallysimple. It can effectively strengthen ascending aorta stump, reduce proximalanastomosis bleeding and reduce complications such as residual false lumen andpseudoaneurysms. It also had great efficacy in patients whose aortic dissectioninvolves aortic valve conjunction,which lead to aortic incompetence. The methodsproves good clinical outcomes in type A aortic dissection patients and is worth ofpromotion.