Modified Arch Repair In Aortic Acrh Aneurysm Treatment

Objective:To summarize the experience of modified arch repair in aortic arch aneurysmstreatment.Method:13patients with aortic arch aneurysms were treated between September2009and January2015at cardiovascular department of2ndhospital of Jilin University.Retrospective study of pre-operative clinical material. surgical methods.cardio-pulmonary bypass methods. postoperative recovery conditions and mid-termfollow-up results.Result:All the patients were male, aged between29-75years old, average of (55.23±14.74).Etiology contained8true aneurysms,5pseudoaneurysms and2of them weretraumatic pseudoaneurysms.Average diameters ranged from50mm to80mm.3operations were urgent,1patient wasacute aortic dissection with aneurysm ruptureinto the thorax,1of them is aneurym concomitant with aortic dissection and1patient was aneurysm rupture into the thorax. Other10patients were selective. Allthe patients accepted modified arch repair under general anesthesia andcardio-pulmonary bypass. A novel graft-stent was used in modified aortic repair. Thegraft is inserted into the descending aorta through the transected aortic arch. Therepair was performed depending on the extension of the aneurysm. The archreconstruction was performed from the inside of aortic arch in an island fashionwithout replacing epi-aortic vessels. Concomitant operations were1ascending-rightcarotid artery bypass due to innominate artery stenosis,1ascending-leftsubclavian-right subclavian artery bypass due to stenosis of left and right artery stenosis,1replacement of aortic valve and ascending aorta due to aneurysm of aorticarch and ascending aorta and aortic root. There was no death and permanentneurological deficit in three patients. Concerning postoperative patients,1case oftemporary delirium,1case of AKI,who recovered before discharge,happened inopen surgery patients. A total of13patients were followed up2-70months.1patientdie of respiratory tract stenosis3months postoperatively. There were nocomplications such as stent displacement and aneurysm reccurence. All the12patients recovered well and are satisfied with their life.Conclusion:Modified arch repair avoids the risk of the complexity in operative procedure,more haemorrhage in replacing epi-aortic vessels compared to traditional aortic archreplacement, which results in less complications and less mortality. Adoptation ofnew graft stent simplifies operation procedures,which avoids the problem ofuncontrollable heamorrhage in aortic arch repair and decreases the amount of bloodtransfusion. Modified arch repair is a safe and reliable technique in aortic arch repairworth promotion for its low mortality rate and less complications.