| Objective To compare the mid-long term outcome of the clinical treatment of Stanford type A aortic dissection in arotic root by analyzing the data of follow-up at a single center.Materials and Methods A total of 425 patients(85 females,aged 22-73 years)with an average(47.01 ± 10.66)years of age,were enrolled in this study.They were all patients with Stanford type A aortic dissection selected from Cardiovascular Surgery of Wuhan Union Hospital from February 2010 to June 2016 with body weight 44-115 kg,mean(74.53 ± 10.51)kg.All patients underwent color Doppler ultrasonography and total aortic CTA examination to make sure the diagnosis of Stanford type A aortic dissection.Surgery of aortic root include the ascend aorta replacement in 126 cases,no coronary sinus angioplasty surgery in 60 cases,David surgery in 4 cases,Bentall surgery in 235 cases.37 cases died in the perioperative period(30 days after surgery),the mortality rate was 8.71%(37 / 425).Another 14 cases with serious complications of persistent coma in 5 cases,2 cases of brain death,high paraplegia in 2 cases,renal failure continued dialysis in 3 cases,2 cases of respiratory failure,discharged to give up treatment due to personal reasons of family members.42 cases(9.88%)were lost during the follow-up period.In addition to peripheral surgical death(37 cases)and abandonment of treatment(14 cases),the remaining patients were followed up for 1-77 months(mean,22.39 ± 19.53 months).255 cases reviewed the Doppler color echocardiographic,83 cases reviewed the total aortic CTA,83 cases reviewed both two.The remaining cases were asked whether the patient survived or not,the quality of life,the survival time,and assessed the cardiac function by NYHA classification.All data were grouped by different aortic root surgery.Results Of the 332 follow-up cases,44 were died out of hospital and the total mortality was 13.25%.27 cases died among them had cerebral hemorrhage(5 cases),cerebral infarction(3 cases),respiratory failure(4 cases),renal failure(6 cases),heart failure(4 cases),severe infection(1 cases)and the remaining 5 cases died of unknown causes.Another 17 cases(1 case died of multiple organ dysfunction syndrome caused by infective endocarditis complicated with cerebral infarction in 9 months after discharge,3 cases died after discharged due to renal failure in 1 year,2 years,2 years respectively,2 cases died due to respiratory failure within 1 year complicated with heart failure)discharged healthily.The remaining 11 cases died of unknown causes.There were 4 cases of David surgery and without death cases in perioperative and follow-up period.During the follow-up period all cases' cardiac function ranged I-II level and 2 cases combined with respiratory insufficiency while charged.But the sample number is small,poor representation and can not be compared with the other three surgical methods.There were 126 AAR cases and the perioperative mortality(7.94%),perioperative complications rate(8.73%),out-of-hospital mortality(4.46%)and complications Incidence rate(6.25%)was the lowest in these three aortic root surgical procedures.Color Doppler echocardiography showed aortic valve insufficiency rate was 13.79%.Postoperative CTA showed a good overall shape of the aorta,artificial torture without tortuous torture,no dissecting aneurysms and 12 cases with persistent false lumen.The cardiac function in follow-up period ranged NYHA class I-II.The mid-long term survival rate was 95.54%.There were 60 cases of no coronary sinus angioplasty in the aortic root surgery combined with reserving aortic valve.In the perioperative period,the mortality of 15.00% and complication rate of 18.33%,and 26.00% in the outpatient complication were the highest in all three surgeries value.The follow-up mortality rate of 18.00% was slightly less than 18.07% in Bentall surgery.Cardiac ultrasonography in follow-up period showed aortic valve regurgitation(25%)and anastomotic leakage(25%)were higher than the other two surgical modalities.The diameter of the ascending aorta in CTA was smaller than that of the Bentall group,and the whole blood vessel was well shaped.There was no tortuous torture in the artificial blood vessel.9 cases combined with the persistent false lumen,and the false lumen in 1 case was completely thrombotic.During the follow-up period,1 case of moderate AR and 1 severe AR patients were reopened at 1 year and 2 years after discharged to replace the aortic valve,and another 1 case of ameliorative formation underwent the re-intervention due to dissecting aneurysm.2 cases in postoperative follow-up showed the cardiac function of NYHA III-IV.The remaining cases showed no heart failure related performance.The interim survival rate was 82.00%.The amount of the replacement of aorta root combined with aortic valve,Bentall surgery,was 235 cases.Perioperative mortality was lower in Bentall surgery(7.66%)than in simple ascending aorta(8.73%)and without coronary sinus angioplasty(15.00%).The incidence of perioperative complications(11.91%)was higher than that of ascending Aortic dissection(8.73%),but lower than that of without coronary sinus angioplasty group(18.33%).The incidence of complications during the follow-up period was 15.06% of Bentall's surgery was higher than 4.46% of ascending aorta replacement,but was lower than 26.00% of the no coronary sinus angioplasty.The follow-up mortality(18.07%)of Bentall surgery was higher than that of ascending aorta replacement and no coronary sinus angioplasty.There was only 2 cases of mild aortic valve insufficiency in follow-up period.The false lumen existed in ET stent persistently in the CTA follow-up cases.The diameter of the ascending aorta is smaller than that of the thoracic descending aorta and the abdominal aorta.1 case underwent operation due to the formation of pseudo aneurysm in the posterior aortic root.4 cases underwent the re-intervention operation due to the formation of the dissecting aneurysm in abdominal aorta or iliac artery dissection.5 cases of cardiac function ranged III-IV grade,other cases without left ventricular dysfunction.The interim survival rate was 81.93%.The overall survival rate was 93.98%,89.76%,87.35% and 86.75% respectively in the first half year,one-year,three-year and five-year.There was no significant difference in the shore-term survival rate of each procedure.Conclusion 1.Overall,the of the surgical treatment of single-center Stanford A-type aortic dissection is similar to the most of the research center,and the re-operation rate is low,the patient's postoperative quality of life is of satisfaction.2.The medium-term survival rate of the simple ascending aortic replacement of the aortic dissection root is high,the incidence of complications is low,no recurrence of surgical cases,the results of follow-up is satisfactory.However,this procedure is only applicable to cases of aortic dissection that are not involved in the roots.3.Reserving the aortic valve of the aortic dissection make the valve insufficiency and anastomotic leakage rate during the follow-up higher,therefore the re-operation rate increased.4.The postoperative valve activity is good in the Bentall surgery,but the incidence of anastomotic leakage is higher.Most patients' heart function is assessed for NYHA I-II,and the quality of life is satisfactory. |
PDF Full Text Request