Clinical Treatment Experience Of 121 Patients With Aortic Dissection

Objective: To analyze the curative effect of aortic dissection and summarize the clinical experience.Methods: A retrospective analysis of the clinical data of 121 patients with surgical treatment of aortic dissection from January 2015 to December 2017 in our hospital.Males 95 cases(78.5%)and females 26 cases(21.5%),aged 25~87 years old,with an average of 50.8±11.7 years old.Patients with type A aortic dissection accounted for 41 cases(17 open surgery and 24 hybrid total artic arch replacement),simple ascending aortic replacement in 1 case;ascending aorta replacement+total artic arch replacement+ elephant trunk stent implantation in 8 cases,1 case of coronary artery bypass grafting during the same period;Bentall operation was performed in 2 cases;Bentall operation+ ascending aorta replacement+total artic arch replacement +elephant trunk stent implantation in 4 cases,1 case of coronary artery bypass grafting during the same period;Improved David operation+total artic arch replacement+elephant trunk stent implantation in 2 cases;ascending aorta replacement+hybrid total artic arch replacement in 22 cases;Bentall operation+ hybrid total artic arch replacement in 2 cases.Patients with type B aortic dissection accounted for 80 cases,all of them used endovascular aortic repair,using left subclavian artery stent-graft placement and left carotid artery stent-graft placement and exploratory thoracotomy in 1 case for each during the same period.Results: There were 6 deaths in the whole group,the death rate was 5.0%.41 patients with type of Standford A aortic dissection(4 cases of death),the mortality rate was 9.8%;80 patients with type of Standford B aortic dissection(2 cases of death),the mortality rate was 2.5%.For 34patients(excluding the death patients)involved aortic arch surgery,the duration of hospitalize-tion was 12~63 days,with an average of 22.06±9.01 days;thepostoperative hospitalization time was 11.5~61.8 days,with an average of 21.96±8.76 days;postoperative tracheal intubation time was 0.65~7 days,with an average of 3.79±4.96 days;the duration of ICU was 1.65~27.5 days,with an average of 6.65±6.36 days;the operation time was 423~830min,with an average of 536.35±106.96min;extracorporeal circulation time was 137~390min,with an average of 204.82±61.11min;cardiac block time was 68~262min,with an average of 113.94±46.27min;the auxiliary cycle time was 50~143min,with an average of 72.61 ±21.08 min.Conclusions:1.Surgical treatment should be the first choice for patients of the type Stanford A aortic dissection.2.Multidisciplinary team collaboration is the fundamental guarantee for the successful completion of the operation.3.Individualized surgical options were selected according to the detailed classification of aortic dissection.4.For conditional hospitals,hybrid totall bow surgery is also a viable surgical treatment.