Different Surgical Strategies for Acute Stanford Type A Aortic Dissection: A 5-year Single-center Experience_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHIEn-yi ,  GUTian-xiang , YUYang , MAONai-hui , YULei , WANGChun , ZHANGYu-hai , FANGQin

Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, P. R. China;

Corresponding author：

GUTian-xiang, Email: cmugtx@sina.com

Keywords：

Aortic dissection; Acute Stanford type A; Surgery

DOI：

10.7507/1007-4848.20140058

Video：

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Objective To summarize clinical experience of different surgical strategies for the treatment of acute Stanford type A aortic dissection (AD). Methods Clinical data of 197 patients with acute Stanford type A AD who underwent surgical treatment in the First Affiliated Hospital of China Medical University from January 2008 to November 2012 were retrospectively reviewed. There were 131 males and 66 females with their age of 24-77 (51.2±13.9) years. All the patients received magentic resonance imaging (MRI) or aortic CT angiography (CTA) for the establishment of diagnosis. According to different aortic root conditions,ascending aorta replacement,Bentall,Wheat,Cabrol or David procedures were performed. Total arch replacement, hemiarch replacement or simplified total arch replacement was also performed for aortic arch dissection combined with stented elephant trunk implantation. Results A total of 113 patients (57.4%) underwent isolated ascending aorta replacement,67 patients (34.0%) received Bentall procedure,13 patients (6.6%) received Wheat procedure,1 patient(0.5%) received Cabrol procedure,and 3 patients (1.5%) received David procedure. Eighty-two patients (41.6%) underwent total arch replacement combined with stented elephant trunk implantation,77 patients (39.1%) received hemiarch replacement, and the other 41 patients (20.8%) received simplified total arch replacement combined with stented elephant trunk implantation. One patient (0.5%) underwent reexploration for postoperative bleeding. No permanent neurological complication occurred. Thirty-day mortality after surgery was 4.1% (8/197). Follow-up duration was 3-52 (15.9±11.4) months with the follow-up rate of 65.0%. One patient with Marfan syndrome died of abdominal aortic aneurysm rupture 8 months after surgery. Conclusion According to different AD conditions, appropriate surgical strategies can be chosen to achieve satisfactory clinical outcomes for patients with acute Stanford type A AD.

Citation： SHIEn-yi, GUTian-xiang, YUYang, MAONai-hui, YULei, WANGChun, ZHANGYu-hai, FANGQin. Different Surgical Strategies for Acute Stanford Type A Aortic Dissection: A 5-year Single-center Experience. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 198-202. doi: 10.7507/1007-4848.20140058 Copy

1.	Bonser RS,Ranasinghe AM,Loubani M,et al.Evidence,lack of evidence,controversy,and debate in the provision and performance of the surgery of acute type A aortic dissection.J Am Coll Cardiol,2011,58 (24):2455-2474.
2.	Karthikesalingam A,Holt PJ,Hinchliffe RJ,et al.The diagnosis and management of aortic dissection.Vasc Endovascular Surg,2010,44 (3):165-169.
3.	Sun L,Qi R,Zhu J,et al.Repair of acute type A dissection:our experiences and results.Ann Thorac Surg,2011,91 (4):1147-1152.
4.	Shi E,Gu T,Yu L,et al.Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation.J Thorac Cardiovasc Surg,2011,142 (6):1458-1463.
5.	师恩祎,谷天祥,喻磊,等.无名动脉插管简化支架"象鼻"手术治疗De BakeyⅠ型主动脉夹层.中国胸心血管外科临床杂志,2010,17 (5):433-434.
6.	Sun L,Qi R,Zhu J,et al.Total arch replacement combined with stented elephant trunk implantation:a new "standard" therapy for type A dissection involving repair of the aortic arch? Circulation,2011,123 (9):971-978.
7.	Sun LZ,Qi RD,Chang Q,et al.Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:Experience with 107 patients.J Thorac Cardiovasc Surg,2009,138 (6):1358-1362.
8.	孙立忠,刘志刚,常谦,等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志,2004,42 (13):812-816.
9.	Ergin MA,Uysal S,Reich DL,et al.Temporary neurological dysfunction after deep hypothermic circulatory arrest:a clinical marker of long-term functional deficit.Ann Thorac Surg,1999,67 (6):1887-1890.
10.	Westaby S,Saito S,Katsumata T.Acute type A dissection:Conservative methods provide consistently low mortality.Ann Thorac Surg,2002,73 (3):707-713.
11.	Kazui T,Yamashita K,Washiyama N,et al.Aortic arch replacement using selective cerebral perfusion.Ann Thorac Surg,2007,83 (2):S796-S798.
12.	Mizunoa T,Toyamab M,Tabuchi N,et al.Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection.Eur J Cardiothorac Surg,2002,22 (4):504-509.
13.	Ohtsubo S,Itoh T,Takarabe K,et al.Surgical results of hemiarch replacement for acute type A dissection.Ann Thorac Surg,2002,74 (5):S1853-S1856.
14.	Shiono M,Hata M,Sezai A,et al.Validity of a limited ascending and hemiarch replacement for acute type A aortic dissection.Ann Thorac Surg,2006,82 (5):1665-1669.
15.	Cui Y,Lu F,Han L,et al.Selective left subclavian ligation in total aortic arch replacement.Ann Thorac Surg,2012,93 (1):110-114.
16.	Kato M,Kuratani T,Kaneko M,et al.The results of total arch graft implantation with open stent-graft placement for type A aortic dissection.J Thorac Cardiovasc Surg,2002,124 (3):531-540.
17.	Liu ZG,Sun LZ,Chang Q,et al.Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.J Thorac Cardiovasc Surg,2006,131 (1):107-113.
18.	Uchida N,Katayama A,Tamura K,et al.Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection.Eur J Cardiothorac Surg,2011,40 (5):1066-1071.
19.	Sun L,Li M,Zhu J,et al.Surgery for patients with Marfan syndrome with type A dissection involving the aortic arch using total arch replacement combined with stented elephant trunk implantation:The acute versus the chronic.J Thorac Cardiovasc Surg,2011,142 (3):e85-e91.
20.	于存涛,孙立忠,常谦,等.人工四分支血管在主动脉外科的应用.中华外科杂志,2005,43 (18):1181-1183.

1. Bonser RS,Ranasinghe AM,Loubani M,et al.Evidence,lack of evidence,controversy,and debate in the provision and performance of the surgery of acute type A aortic dissection.J Am Coll Cardiol,2011,58 (24):2455-2474.
2. Karthikesalingam A,Holt PJ,Hinchliffe RJ,et al.The diagnosis and management of aortic dissection.Vasc Endovascular Surg,2010,44 (3):165-169.
3. Sun L,Qi R,Zhu J,et al.Repair of acute type A dissection:our experiences and results.Ann Thorac Surg,2011,91 (4):1147-1152.
4. Shi E,Gu T,Yu L,et al.Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation.J Thorac Cardiovasc Surg,2011,142 (6):1458-1463.
5. 师恩祎,谷天祥,喻磊,等.无名动脉插管简化支架"象鼻"手术治疗De BakeyⅠ型主动脉夹层.中国胸心血管外科临床杂志,2010,17 (5):433-434.
6. Sun L,Qi R,Zhu J,et al.Total arch replacement combined with stented elephant trunk implantation:a new "standard" therapy for type A dissection involving repair of the aortic arch? Circulation,2011,123 (9):971-978.
7. Sun LZ,Qi RD,Chang Q,et al.Surgery for acute type A dissection using total arch replacement combined with stented elephant trunk implantation:Experience with 107 patients.J Thorac Cardiovasc Surg,2009,138 (6):1358-1362.
8. 孙立忠,刘志刚,常谦,等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志,2004,42 (13):812-816.
9. Ergin MA,Uysal S,Reich DL,et al.Temporary neurological dysfunction after deep hypothermic circulatory arrest:a clinical marker of long-term functional deficit.Ann Thorac Surg,1999,67 (6):1887-1890.
10. Westaby S,Saito S,Katsumata T.Acute type A dissection:Conservative methods provide consistently low mortality.Ann Thorac Surg,2002,73 (3):707-713.
11. Kazui T,Yamashita K,Washiyama N,et al.Aortic arch replacement using selective cerebral perfusion.Ann Thorac Surg,2007,83 (2):S796-S798.
12. Mizunoa T,Toyamab M,Tabuchi N,et al.Stented elephant trunk procedure combined with ascending aorta and arch replacement for acute type A aortic dissection.Eur J Cardiothorac Surg,2002,22 (4):504-509.
13. Ohtsubo S,Itoh T,Takarabe K,et al.Surgical results of hemiarch replacement for acute type A dissection.Ann Thorac Surg,2002,74 (5):S1853-S1856.
14. Shiono M,Hata M,Sezai A,et al.Validity of a limited ascending and hemiarch replacement for acute type A aortic dissection.Ann Thorac Surg,2006,82 (5):1665-1669.
15. Cui Y,Lu F,Han L,et al.Selective left subclavian ligation in total aortic arch replacement.Ann Thorac Surg,2012,93 (1):110-114.
16. Kato M,Kuratani T,Kaneko M,et al.The results of total arch graft implantation with open stent-graft placement for type A aortic dissection.J Thorac Cardiovasc Surg,2002,124 (3):531-540.
17. Liu ZG,Sun LZ,Chang Q,et al.Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.J Thorac Cardiovasc Surg,2006,131 (1):107-113.
18. Uchida N,Katayama A,Tamura K,et al.Frozen elephant trunk technique and partial remodeling for acute type A aortic dissection.Eur J Cardiothorac Surg,2011,40 (5):1066-1071.
19. Sun L,Li M,Zhu J,et al.Surgery for patients with Marfan syndrome with type A dissection involving the aortic arch using total arch replacement combined with stented elephant trunk implantation:The acute versus the chronic.J Thorac Cardiovasc Surg,2011,142 (3):e85-e91.
20. 于存涛,孙立忠,常谦,等.人工四分支血管在主动脉外科的应用.中华外科杂志,2005,43 (18):1181-1183.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Different Surgical Strategies for Acute Stanford Type A Aortic Dissection: A 5-year Single-center Experience

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