Study On The Correlation Between Surgical Prognosis And Timing Of Acute Complicated Stanford Type A Aortic Dissection

Objective:To explore the early and long-term effects of Sun's operation on acute complicated Stanford type A aortic dissection.To analyze comparatively the effect of different operative timing on the prognosis of acute complicated Stanford type A aortic dissection,and expect to help decide the operation timing of it.Methods:A retrospective analysis of acute complicated Stanford type A aortic dissection with surgical treatment conductd in March 2012 to December 2012 in Beijing Anzhen Hospital was made.A total of 92 cases were summarized and all patients were performed with modified total aortic arch replacement and stent elephant trunk technique treatment(Sun's operation).Preoperative,intraoperative and postoperative information was collected in the patients.Preoperative information included sex,age,weight,hypertension,diabetes,nervous system dysfunction,hemopericardium,acute heart failure,acute renal failure,limb ischemia,abdominal viscera ischemia,degree of aortic valve insufficiency,and the time from onset to surgery.Intraoperative information including extracorporeal bypass time,aorta blocking time,deep hypothermic circulatory arrest time,selective cerebral perfusion time and assisted circulation time were collected.Short-term postoperative data included death,rethoracotomy for bleeding,severe neurological complication,low cardiac output syndrome,tracheotomy,renal failure,spinal cord ischemia,hoarseness.There were death,new complication and cardiovascular reoperation in the follow-up data.According to the time from onset to surgery,the patients were divided into three groups,including the first time group(T1,<24 h),the second time group(T2,24h to 7 days),the third time group(T3,more than 7 days).The comparative analysis of three groups of patients was made in preoperative,intraoperative and postoperative differences,and the impact of operation timing on therapeutic effect of Sun's operation was evaluated.Results:1.This study collected a total of 92 patients uderwent modified total aortic arch replacement and stent elephant trunk technique.9 cases died after operation(9.8%),4 cases were conducted with rethoracotomy for bleeding(4.3%),12 patients with neurological complications were found(13.0%),8 cases were happened with renal failure(8.7%),and there were 3 cases of tracheotomy(3.3%),2 cases of severe low cardiac output syndrome(2.2%),1 case of limb ischemic necrosis(2.2%),1 case of spinal cord ischemia(2.2%)and 1 case of hoarseness(2.2%).2.There are 20 patients in the first time group,52 patients in the second time group,20 patients in the third time group.Preoperative general data,including sex,age,weight,hypertension,diabetes,nervous system dysfunction,hemopericardium,acute heart failure,acute renal failure,limb ischemia,abdominal viscera ischemia,severe aortic valve insufficiency was proved with no significant difference(P>0.05).In the extracorporeal byppass time and aorta blocking time,the first group was more than the second time group and the third time group,and the difference between them was statistically significant(P<0.05).There was no statistically significant difference in the time of deep hypothermic circulatory arrest time,selective cerebral perfusion time and assisted circulation time between three groups(P>0.05).Three groups of patients in surgical mortality,rethoracotomy for bleeding,severe neurological complication,low cardiac output syndrome,tracheotomy,renal failure,limb ischemic necrosis,spinal cord ischemia,hoarseness were confirmed with no statistically significant difference(P>0.05).Deaths,new complications,cardiovascular reoperations in the follow-up period were also the same.Conclusion:1.Sun's operation is a safe and effective method for the treatment of acute complicated Stanford type A aortic dissection with low mortality and complication occurrence rate.2.Operation time has no significant effect on the surgical treatment of patients of acute complicated Stanford type A aortic dissection.The extracorporeal byppass time and aorta blocking time were less in operations in early stage of the course of the disease,but deep hypothermic circulatory arrest time,cerebral perfusion time and assisted circulation time were with no difference.Early operation had no negative impact on the mortality of Sun's operation.Neither the incidence of short-term complication nor long-term complication was confirmed with significant difference.As the high risk of mortality of the acute complicated Stanford type A aortic dissection treated by conservative therapy,operation is necessary to be conducted instantly.