| Objective:sun's procedure has become a standard surgery for repair of type A aortic dissection.However,the anastomosis for branch vessels is relatively complicated,and the duration of hemostasis in the operation is relatively longer.In order to simplify the processing of the aortic arch and enhance the operative outcomes,we conducted a modified operation based on the island technique for aortic arch and compared the clinical effects of two surgical methods of modified island technology and traditional sun's procedure for aortic arch in the treatment of type A aortic dissection.Methods:Between January 2011 and November 2017,479 patients from Guangdong General Hospital with type A aortic dissection underwent surgical repair using two different aortic arch treatment,including 312 patients with traditional sun's procedure and 167 patients with modified island anastomosis technique.Because of the significant differences in the distribution of some of the main features of the two groups,propensity score matching was performed with the Match Ratio set to 1:0.8 by the way.On the basis of Statistical Package for the Social Science,the patients were divided into traditional sun's produce group and modified island technique group.There were 51 patients(39 men and 12 women)with type A aortic dissection in the traditional sun's produce group,mean age 54.27±9.52 years old.There were 42 patients(29 men and 13 women)with type A aortic dissection in the modified island technique group,mean age 50.27±11.57 years old.Followed up was performed by means of CT and echocardiographic examination on the following schedule:before discharge,3 months,and annually thereafter.Results:In the traditional sun's produce group,the CPB time was 223.22±35.44 minutes;cross-clamp time was 157.78±21.93 minutes;antegrade cerebral perfusion was 30.59±4.70 minutes and total operating time was 512.25±62.99 minutes.The hospital mortality rate was 5.88%(3 patients).Two patients(3.92%)exhibited permanent neurologic dysfunction,and eleven patients(21.57%)exhibited transient neurologic dysfunction.Eleven patients(21.57%)with acute renal failure required dialysis postoperatively.Two patients(3.92%)required reexploration for bleeding.The follow-up was 15.78±7.93 months.There was no death or reoperation during the follow-up period.The false lumen thrombus of the descending aorta was 89.58%.In the modified island technique group,the CPB time was 198.07±30.98 minutes;cross-clamp time was 141.48±22.51 minutes;antegrade cerebral perfusion was 24.55±3.65 minutes and total operating time was 415.71 ±68.16 minutes.The hospital mortality rate was 2.38%(1 patients).There was no patient exhibited permanent neurologic dysfunction,and seven patients(16.67%)exhibited transient neurologic dysfunction.Six patients(14.29%)with acute renal failure required dialysis postoperatively.One patients(2.38%)required reexploration for bleeding.The follow-up was 11.69±5.76 months.There was no death or reoperation during the follow-up period.A proximal stented endoleak was found in two patients(4.88%)and treated by thoracic endovascular aortic repair during the follow-up.Postoperative computed tomography revealed the patency of the anastomotic site without vascular dilatation of branch vessels.Thrombus obliteration of the false lumen around the stent graft in the descending aorta was found in 38 patients(92.68%).Conclusion:the traditional sun's procedure is a safe and effective method for most of type A aortic dissection.The application of modified island technique in the treatment of aortic dissection has also achieved good clinical results.As a modified method of aortic arch treatment,it simplifies the operation process of aortic arch,and makes bleeding better controlled,and effectively reduces the duration of total operation,and reduces surgical trauma to patients.The expansion of the branch vessels and the aortic arch leakage need to be closely monitored during postoperative follow-up.The survival rate and long-term effect need further study. |
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