| Object:The purpose is to analyze the therapeutic effect of the treatment of aortic dissection(Stanford type A)by the technique of aortic sinus shaping and to summarize the clinical experience.Methods:Retrospective analysis was performed in our hospital from January 2016 to December 2019.Thoracic and abdominal CTA indicated aortic dissection(Stanford type A)in patients with a certain degree of involvement of aortic root lesions,and different aortic valve regurgitation.There were 62 cases in this group,including 44 males and 18 females,with an average age of 45.2 ± 11.28(range 26 ~ 78 years)and an average weight of 72.3 ± 11.7 kg(range 42 ~ 102 kg).Patients with historical high blood pressure were 43 cases.Preoperative heart echocardiography indicated no or minimal regurgitation in 16 cases(25.81%),mild reflux 32 cases(51.61%),light to moderate regurgitation in 12 cases(19.35%),and 2 patients with severe regurgitation(3.22%).The data showed renal artery made and impaired renal function 27 patients(43.55%),lung infection 14 cases(22.58%).Preoperative blood pressure and heart rate were strictly controlled,and intraoperative aortic valve exploration of the patients was strengthened,we used the aortic sinus shaping technology to treat the aortic dissection(Stanford type A).The whole treatment process of the patients was observed.The basic conditions before and after the operation were recorded,such as the level of aortic valve regurgitation,the complications,the duration of aortic occlusion,Total time of cardiopulmonary bypass,Cycle stop time at low temperature,the time needed to recover to the awake state after the operation and the length of stay in the intensive care unit.During 1 ~ 3 months follow-up period when patients were in or out of the hospital,we recorded patient's conditions,including cured,death and other related indicators,by the review of the chest CTA,heart echocardiography evaluation of aortic sinus reconstruction and aortic regurgitation.We analyzed the clinical effect from the above results in the aortic sinus plasty,and summarize the clinical experience.Results:All patients were treated with aortic sinus plasty(Stanford type A).There were no deaths during the operation and no cases of secondary thoracotomy for hemostasis.The total time of CPB averaged 165 ± 27.4 min(range 110 ~ 272 min),the average time of aortic occlusion was 112.3 ± 18.7 min(range 82 ~ 167 min),the average time of deep hypothermia shutdown was 5.2 ± 1.9 min(range 4~10 min),and the average time of recovery to sober after successful operation was 498.9 ± 77.6 min(range255~695 min).Average postoperative respirator assisted breathing takes 25.8 ± 17.6 h(range 13 ~ 87 h),average closely into the intensive care unit treatment takes 68.4 ±26.3 h(range 43 ~ 147 h),average hospitalization time after the surgery of 16.2 ± 4.1d(range 6 ~ 24 d),before the operation of aortic sinus 34.73 ± 4.238 mm in diameter(range 28 ~ 43 mm),hospital stay and postoperative review of aortic sinus 28.62 ±5.16 mm in diameter(range 22 ~ 38 mm).In this group,18 patients(29.03%)had liver dysfunction after operation,12 cases(19.35%)had received continuous renal replacement therapy due to abnormal renal function,8 cases(12.90%)had a more severe pulmonary infection,2 cases(3.22%)had cerebral infarction,and 1 case(1.61%)had hemiplegia/paraplegia.The postoperative results of aortic valve regurgitation showed that 41 patients(66.12%)had no or minimal regurgitation,17cases(27.42%)had mild regurgitation,4 cases(6.45%)had mild to moderate regurgitation,and no patients had moderate to severe regurgitation.According to the postoperative outcome,55 cases(88.71%)were cured and discharged,and 4 cases(6.45%)died in hospital and 3 cases(4.84%)were discharged automatically.During 1~ 3 months follow-up period,the outpatient review,improvement of cardiac echocardiography and chest and abdomen CTA examination,indicated stable condition.The proportion of aortic valve regurgitation was stable compared with the preoperative diagnosis and treatment effect,the aortic sinus reconstruction was great,indicating the diagnosis and treatment effect was accurate.Conclusions:1.The aortic sinus shaping technology was used to treat the aortic dissection(Stanford type A),and the reinforcement of the aortic sinus was viable.This operation method was simpler and more effective,and the hemostasis was easier.It not only simplifies the operation process,but also shortens the operation time.The diagnosis and treatment effect is more accurate.2.In this study,aortic sinus shaping technology was adopted to retain the aortic valve.Compared with the classic Bentall surgery,the left and right coronary mouth transplantation,intraoperative hemostasis and postoperative anticoagulant complications were avoided,and the clinical cure rate was improved,which is of great significance for the patient's prognosis and long-term postoperative survival rate.3.In this study,a single center was used for retrospective analysis.Due to the limited number of patients,and few cases were included in this research,its short-term efficacy was accurate.The long-term therapeutic effect of diagnosis and treatment needs to be further studied and observed in a large sample center. |
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