The Effect Of Bentall's And Sun's Procedure On Acute Stanford Type A3 Aortic Dissection

Objective: To summarize the clinical experience of Bentall's and Sun's procedure on acute Stanford type A3 aortic dissection in Sun Yat-sen Cardiovascular Hospital.Methods: All patients who underwent acute Stanford type A3 aortic dissection surgery between September 2016 to December 2018 in Sun Yat-sen Cardiovascular Hospital were retrospectively analyzed in our study.There were 42 patients with 36 males and 6 females at age of 22~67 years,mean age of 41.36±12.23 years.There were 30 cases(71.4%,30/42)in emergency operation and 12 cases(28.6%,12/42)in limited operation.All patients underwent moderate hypothermic circulatory arrest with low-flow selective cerebral perfusion.The procedures were Bentall's(Ascending aorta with valve artificial blood vessel replacement)and Sun's procedure(aortic total arch replacement and descending aortic stent elephant trunk artificial blood vessel implantation).Results: The average operation time was(605.12±98.16)min,cardiopulmonary bypass time was(231.79±37.52)min,ascending aorta time was(133.62±27.91)min,and circulation arrest time was(19.98±7.29)min.The average hospital stay time was(26.26 ± 11.11)days,ICU stay time was(12.05 ± 3.77)days.There were 6 deaths(14.2%,6/42)during hospitalization,3 deaths due to postoperative multiple organ failure;2 deaths due to postoperative respiratory and circulatory failure;and 1 death due to distal dissection.Postoperative complications occurred in 19 patients(45.2%,19/42),including 3 cases of secondarythoracotomy(9.5%,3/42);11 cases of neurological complications(26.2%,11/42);6 cases of acute kidney injury(AKI)(14.3%,6/42);3 cases of acute hepatic injury(AHI)(7.1%,3/42);2 cases of gastrointestinal hemorrhage(4.8%,2/42);2 cases of pulmonary infection(11.9%,5/42).The patients were followed up for 3 to 30 months until March 2019.36 patients were followed up,and the follow-up rate was 85.7%.The whole group was followed up for aortic CTA and echocardiography,showed that the main vessels of the artificial blood vessels and their branches and vessels were patency,without distortion,stenosis and displacement,there were no obvious reflux and leaflet activity was good,no new hair was found in the aorta,and the distal stent was satisfactorily attached.The aortic arch and the descending aorta of the thoracic artery showed partial thrombosis.No aortic aneurysm or aortic dissection was found and no pseudoaneurysm associated with the anastomosis occurred.Conclusion:1.For the acute Stanford type A3 aortic dissection,early Bentall's and Sun's procedure can save the patient's life and achieve satisfactory consequences;2.Moderate hypothermic circulatory arrest and selective cerebral perfusion provide positive brain protection and surgery support;3.The technical improvement of the surgical team is very important to reduce complications and mortality.Surgery and neurological protection methods still need to be improved.