Modified Bentall Procedure for the Treatment of Stanford Type A<sub>3</sub> Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

INWei , HUANGFu-hua ,  CHENXin , LIUSheng-chen

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Hospital, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding author：

CHENXin, Email: stevecx@sina.com

Keywords：

Aortic dissection; Bentall procedure; Modification; Efficacy

DOI：

10.7507/1007-4848.20140209

Video：

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Objective To summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A₃ aortic dissection (AD). Methods Fifty-four patients with Stanford type A₃ AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. Results There was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. Conclusion Modified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.

Citation： INWei, HUANGFu-hua, CHENXin, LIUSheng-chen. Modified Bentall Procedure for the Treatment of Stanford Type A₃ Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 725-729. doi: 10.7507/1007-4848.20140209 Copy

1.	Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1):311-328.
2.	徐志云, 邹良建, 宋智钢, 等. Stanford A型主动脉夹层外科手术方法和疗效.中华胸心血管外科杂志, 2007, 23(5):295-297.
3.	陈鑫, 黄福华, 徐明, 等.孙氏手术治疗急性Stanford A型主动脉夹层.中华胸心血管外科杂志, 2012, 28(6):333-335.
4.	邱志兵, 陈鑫, 徐明, 等.急性Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2007, 14(6):426-428.
5.	孙立忠, 刘宁宁, 常谦, 等.主动脉夹层的细化分型及其应用.中华外科杂志, 2005, 43(18):1171-1176.
6.	Chen X, Huang FH, Xu M, et al. The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11(5):594-598.
7.	孙立忠, 刘宁宁. Bentall手术.中华胸心血管外科杂志, 2012, 28(12):761-768.
8.	Gott VL, Cameron DE, Alejo DE, et al. Aortic root replacement in 271 Marfan patients:A 24-year experience. Ann Thorac Surg, 2002, 73(2):438-443.
9.	Houel R, Soustelle C, Kirsch M, et al. Long-term results of the Bentall operation versus separate replacement of the ascending aorta and aortic valve. J Heart Valve Dis, 2002, 11(4):485-491.
10.	兰怀, 王辉山, 韩宏光, 等. Bentall手术治疗马方综合征的疗效分析.中国胸心血管外科临床杂志, 2013, 20(1):100-102.
11.	孙立忠, 刘宁宁, 常谦, 等.主动脉手术并同期冠状动脉旁路移植术的临床总结.中华外科杂志, 2006, 44(2):76-79.
12.	Milano AD, Pratali S, Mecozzi G, et al. Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg, 2003, 75(6):1797-1801.
13.	Chwan NA, Yiannikas J, Chiang YA, et al. Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography. J Cardiovasc Comput Tomogr, 2010, 4(3):206-212.
14.	Erkut B, Ceviz M, Becit N, et al. Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography. Heart Surg Forum, 2007, 10(3):e191-e192.
15.	李罗成, 王志维, 吴红兵, 等. Stanford A型主动脉夹层手术中的主动脉根部处理.中华胸心血管外科杂志, 2011, 27(6):331-333.
16.	Urbanski PP, Heinz N, Zhan X, et al. Modifi ed bio-Bentall procedure:10-year experience. Eur J Cardiothorac Surg, 2010, 37(6):1317-1321.
17.	Kim TS, Na CY, Oh SS, et al. Long-Term mortality and morbidity after button bentall operation. J Card Surg, 2013, 28(3):280-284.
18.	Joo HC, Chang BC, Youn YN, et al. Clinical experience with the Bentall procedure:28 years. Yonsei Med J, 2012, 53(5):915-923.
19.	Verbakel KM, van Straten AH, Hamad MA, et al. Results of one-hundred and seventy patients after elective Bentall operation. Asian Cardiovasc Thorac Ann, 2012, 20(4):418-425.
20.	Westaby S, Katsumata T, Vaccari G. Aortic root replacement with coronary button re-implantation:low risk and predictable outcome. Eur J Cardiothorac Surg, 2000, 17(3):259-265.
21.	秦卫, 黄福华, 肖立琼, 等.夜间急诊主动脉夹层手术并不增加住院死亡率.中国胸心血管外科临床杂志, 2013, 20(5):542-545.
22.	秦卫, 黄福华, 陈鑫, 等.深低温停循环联合顺行性脑灌注对患者认知功能的影响.中国胸心血管外科临床杂志, 2014, 21(1):71-74.

1. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1):311-328.
2. 徐志云, 邹良建, 宋智钢, 等. Stanford A型主动脉夹层外科手术方法和疗效.中华胸心血管外科杂志, 2007, 23(5):295-297.
3. 陈鑫, 黄福华, 徐明, 等.孙氏手术治疗急性Stanford A型主动脉夹层.中华胸心血管外科杂志, 2012, 28(6):333-335.
4. 邱志兵, 陈鑫, 徐明, 等.急性Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2007, 14(6):426-428.
5. 孙立忠, 刘宁宁, 常谦, 等.主动脉夹层的细化分型及其应用.中华外科杂志, 2005, 43(18):1171-1176.
6. Chen X, Huang FH, Xu M, et al. The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11(5):594-598.
7. 孙立忠, 刘宁宁. Bentall手术.中华胸心血管外科杂志, 2012, 28(12):761-768.
8. Gott VL, Cameron DE, Alejo DE, et al. Aortic root replacement in 271 Marfan patients:A 24-year experience. Ann Thorac Surg, 2002, 73(2):438-443.
9. Houel R, Soustelle C, Kirsch M, et al. Long-term results of the Bentall operation versus separate replacement of the ascending aorta and aortic valve. J Heart Valve Dis, 2002, 11(4):485-491.
10. 兰怀, 王辉山, 韩宏光, 等. Bentall手术治疗马方综合征的疗效分析.中国胸心血管外科临床杂志, 2013, 20(1):100-102.
11. 孙立忠, 刘宁宁, 常谦, 等.主动脉手术并同期冠状动脉旁路移植术的临床总结.中华外科杂志, 2006, 44(2):76-79.
12. Milano AD, Pratali S, Mecozzi G, et al. Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg, 2003, 75(6):1797-1801.
13. Chwan NA, Yiannikas J, Chiang YA, et al. Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography. J Cardiovasc Comput Tomogr, 2010, 4(3):206-212.
14. Erkut B, Ceviz M, Becit N, et al. Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography. Heart Surg Forum, 2007, 10(3):e191-e192.
15. 李罗成, 王志维, 吴红兵, 等. Stanford A型主动脉夹层手术中的主动脉根部处理.中华胸心血管外科杂志, 2011, 27(6):331-333.
16. Urbanski PP, Heinz N, Zhan X, et al. Modifi ed bio-Bentall procedure:10-year experience. Eur J Cardiothorac Surg, 2010, 37(6):1317-1321.
17. Kim TS, Na CY, Oh SS, et al. Long-Term mortality and morbidity after button bentall operation. J Card Surg, 2013, 28(3):280-284.
18. Joo HC, Chang BC, Youn YN, et al. Clinical experience with the Bentall procedure:28 years. Yonsei Med J, 2012, 53(5):915-923.
19. Verbakel KM, van Straten AH, Hamad MA, et al. Results of one-hundred and seventy patients after elective Bentall operation. Asian Cardiovasc Thorac Ann, 2012, 20(4):418-425.
20. Westaby S, Katsumata T, Vaccari G. Aortic root replacement with coronary button re-implantation:low risk and predictable outcome. Eur J Cardiothorac Surg, 2000, 17(3):259-265.
21. 秦卫, 黄福华, 肖立琼, 等.夜间急诊主动脉夹层手术并不增加住院死亡率.中国胸心血管外科临床杂志, 2013, 20(5):542-545.
22. 秦卫, 黄福华, 陈鑫, 等.深低温停循环联合顺行性脑灌注对患者认知功能的影响.中国胸心血管外科临床杂志, 2014, 21(1):71-74.

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Modified Bentall Procedure for the Treatment of Stanford Type A₃ Aortic Dissection