Modified total arch replacement for surgical repair of Stanford type A aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CAI Shihao ^1,3 ,  FAN Xiaoping ¹ , HUANG Jinsong ¹ , PENG Jihai ² , ZHANG Mingsheng ² , HE Jie ^1,3 , XU Wenliu ³

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;
2. Department of Rehabilitation, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;
3. Graduate School, the Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding author：

FAN Xiaoping, Email: fukui-hanson@hotmail.com

Keywords：

Aortic dissection; surgery; hypothemia; selective cerebral perfusion

DOI：

10.7507/1007-4848.201803073

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the safety and effectiveness of modified total arch replacement by retrospectively analyzing the clinical outcome of surgical patients with Stanford type A aortic dissection (AAD). Methods From June 2015 to December 2016, 39 consecutive patients with AAD were recruited to this study. This modified technique was preformed under general anesthesia and a 30℃ hypothermia circulatory arrest (HCA) with continual bilateral antegrade cerebral perfusion. Different surgical approaches were applied according to the aortic root condition: Bentall procedure (4 patients), David procedure (2 patients), aortic valve plasty and ascending aortic replacement (25 patients) and Cabrol procedure (8 patients). Concomitant procedures included mitral valve plasty (1 patient) and tricuspid valve plasty (1 patient). Results The average cardiopulmonary bypass (CPB), aortic occlusion time (ACC), HCA and operation time was 218.5±42.2 min, 134.2±32.4 min, 4.9±2.3 min and 415.5±80.5 min respectively. Four patients required dialysis and 2 patients developed temporary neurological deficit. No permanent neurological deficit, postoperative paraplegia or in-hospital death occurred. Computed tomography examination was performed on all patients before discharge and 3 months after discharge. The follow-up result showed that 37 patients developed complete thrombosis in the false lumen and 2 patients developed partial thrombosis. Conclusion Modified total arch replacement is a safe and effective approach for AAD. It can greatly avoid postoperative complications and provide satisfactory short-term outcomes.

Citation： CAI Shihao, FAN Xiaoping, HUANG Jinsong, PENG Jihai, ZHANG Mingsheng, HE Jie, XU Wenliu. Modified total arch replacement for surgical repair of Stanford type A aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(11): 962-966. doi: 10.7507/1007-4848.201803073 Copy

1.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2.	Ma WG, Zheng J, Liu YM, et al. Dr. Sun's procedure for type A aortic dissection: total arch replacement using tetrafurcate hraft with stented elephant trunk implantation. Aorta (Stamford), 2013, 1(1): 59-64.
3.	Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg, 2016, 5(4): 346-351.
4.	Jr TY, Kavarana MN. Cardiopulmonary bypass and the coagulation system. Progr Pediatr Cardiol, 2005, 21: 87-115.
5.	Parve S, Ziganshin BA, Elefteriades JA. Overview of the current knowledge on etiology, natural history and treatment of aortic dissection. J Cardiovasc Surg (Torino), 2017, 58(2): 238-251.
6.	Reich DL, Uysal S, Sliwinski M, et al. Neuropsychologic outcome after deep hypothermic circulatory arrest in adults. J Thorac Cardiovasc Surg, 1999, 117(1): 156-163.
7.	Coselli JS, Lemaire SA. Aortic arch surgery: principles, strategies, and outcomes. Wiley-Blackwell, 2008.
8.	Okita Y, Minatoya K, Tagusari O, et al. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72(1): 72-79.
9.	Gaul C, Dietrich W, Erbguth FJ. Neurological symptoms in aortic dissection: a challenge for neurologists. Cerebrovasc Dis, 2008, 26(1): 1-8.
10.	Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery. Eur J Cardiothorac Surg, 2008, 34(5): 953-959.
11.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
12.	Numata S, Tsutsumi Y, Monta O, et al. Mid-long-term results after aortic arch repair using a four-branched graft with antegrade selective cerebral perfusion. J Card Surg, 2013, 28(5): 537-542.
13.	Pacini D, Leone A, Di Marco L, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg, 2007, 31(4): 618-622.
14.	Groeneveld AB, Jansen EK, Verheij J. Mechanisms of pulmonary dysfunction after on-pump and off-pump cardiac surgery: a prospective cohort study. J Cardiothorac Surg, 2007, 2: 11.

1. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
2. Ma WG, Zheng J, Liu YM, et al. Dr. Sun's procedure for type A aortic dissection: total arch replacement using tetrafurcate hraft with stented elephant trunk implantation. Aorta (Stamford), 2013, 1(1): 59-64.
3. Berretta P, Patel HJ, Gleason TG, et al. IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg, 2016, 5(4): 346-351.
4. Jr TY, Kavarana MN. Cardiopulmonary bypass and the coagulation system. Progr Pediatr Cardiol, 2005, 21: 87-115.
5. Parve S, Ziganshin BA, Elefteriades JA. Overview of the current knowledge on etiology, natural history and treatment of aortic dissection. J Cardiovasc Surg (Torino), 2017, 58(2): 238-251.
6. Reich DL, Uysal S, Sliwinski M, et al. Neuropsychologic outcome after deep hypothermic circulatory arrest in adults. J Thorac Cardiovasc Surg, 1999, 117(1): 156-163.
7. Coselli JS, Lemaire SA. Aortic arch surgery: principles, strategies, and outcomes. Wiley-Blackwell, 2008.
8. Okita Y, Minatoya K, Tagusari O, et al. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72(1): 72-79.
9. Gaul C, Dietrich W, Erbguth FJ. Neurological symptoms in aortic dissection: a challenge for neurologists. Cerebrovasc Dis, 2008, 26(1): 1-8.
10. Filsoufi F, Rahmanian PB, Castillo JG, et al. Logistic risk model predicting postoperative respiratory failure in patients undergoing valve surgery. Eur J Cardiothorac Surg, 2008, 34(5): 953-959.
11. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction after surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3): 691-696.
12. Numata S, Tsutsumi Y, Monta O, et al. Mid-long-term results after aortic arch repair using a four-branched graft with antegrade selective cerebral perfusion. J Card Surg, 2013, 28(5): 537-542.
13. Pacini D, Leone A, Di Marco L, et al. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg, 2007, 31(4): 618-622.
14. Groeneveld AB, Jansen EK, Verheij J. Mechanisms of pulmonary dysfunction after on-pump and off-pump cardiac surgery: a prospective cohort study. J Cardiothorac Surg, 2007, 2: 11.

Previous Article
Surgical treatment of pregnancy complicated with aortic dissection
Next Article
Is it time to optimize thoracoscope instruments package of lobectomy in patients with lung cancer?

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified total arch replacement for surgical repair of Stanford type A aortic dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content