Clinical Analysis Of Surgical Treatment Of 33 Cases With Acute Type A Aortic Dissection

Acute type A aortic dissection(ATAAD)is a kind of very dangerous and deadly disease,the effective treatment is surgical intervention.Although the introduction of deep hypothermic circulatory arrest(DHCA)improved surgical results of more extensive operations on the aortic arch,the safe duration of DHCA alone is limited,these complex procedures are still associated with a relatively high mortality and high incidences of neurologic complications.Ever since DHCA combined with the technology of anterograde selective cerebral perfusion(SACP),it obviously prolong the circulatory arrest time.With reasonable SACP flow and pressure,the temperature during circulatory arrest also gradually increase to moderate hypothermic which is more than 20?,but as to the choice of optimum temperature and cerebral perfusion remains controversial.In addition,the choice of the reasonable operation method can improve the treatment effect,reduce the early mortality and incidence of postoperative complications.Objective In this study,we aim to evaluate the application and influencu on postoperative complications of using moderatehypothermic circulatory arrest(MHCA)and selective antegrade cerebral perfusion in the surgery of acute type A aortic dissection,summarize the clinical application experience of using modified total aortic arch replacement in acute type A aortic dissection.Methods From December 2012 to January 2016,33 patients with acute type A aortic dissection undertook surgery in the Department of Cardiovascular Surgery,China-Japan Union Hospital of Jilin University.In the surgeriers,we used MHCA combined with SACP for the cerebral protection:stop the femoral artery perfusion when the nasopharyngeal temperature drop down to 22 ~ 25 ?,and then begin bilateral anterograde cerebral perfusion through the right axillary artery and left common carotid artery intubation,during this period imbedding the stent trunk in the descending aorta and use modified total aortic arch replacement for the arch repair.Withdraw the intubation from the left common carotid artery after the completion of the arch repair,recover the normal flow of the extracorporeal circulation,and then fnish the rest of the operation.Record the condition during operation,observe the postoperative recovery and early postoperative mortality(30 days),the incidence of the central nervous system dysfunction,continuous renal replacement therapy(CRRT),complications of the spinal cord and the important organ,and so on.Results The mean cardiopulmonary bypass(CPB)time was(173.3 ± 51.8)min,the mean myocardial ischemia time was(120.4±25.5)min,the mean SACP time was(36.6±8.1)min,the lowest nasopharyngeal temperature was(23.7±1.0)?,the lowest rectum temperature was(25.5±1.3)?.The early postoperative mortality was 9.1%(3/33),in which 1 case died of multiple organ dysfunction on the fifth days postoperative,1 case died of severe pulmonary infection after secondary thoracotomy for hemostasis,And 1 case died of sudden cardiac arrest 1 week after discharge?TND occurred in 5 patients(15.1%),In discharge all returned to normal;PND occurred in 2 patients(6.1%),1 case had the right limbs mild hemiplegia,Head CT incident left brain cortex new infarcts;The other 1 case of postoperative hyperpyrexia,did not wake up,with ion disorders,soon died of multiple organ failure?4patients(12.1%)need continuous renal replacement therapy(CRRT)postoperation,in which 3 cases of acute renal failure patients were restored to normal renal function after the treatment.Postoperative secondary thoracotomy for hemostasis in2 cases;there is no paraplegia irreversible damage of spinal cord,etc.The rest of the patients whose liver and kidney index appear a certain degree of damage,finally recovery or close to normal at discharge.Conclusion 1.Surgery is the most effective way to the treatment of acute type A aortic dissection,MHCA combined with SACP can provide effective cerebral protection for acute type A aortic dissection surgery,and there is no additional adverse impact to the complications of the nervous system.MHCA have no additional adverse impact to the complications of the spinal cord or internal organs.2.Modified total aortic arch replacement can reduce the anastomotic number,simplify the operation process,shorten the circulatory arrest and extracorporeal circulation time,and thus reduce the ischemia time of spinal cord and the internal organs,minimize the adverse effect on blood coagulation function.This method can be safely and effectively performed for aortic arch repair in the acute type A aortic dissection surgery,but it should select the appropriate surgical indications.