Different surgical procedures for Stanford type A aortic dissection: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAO Yinglu , WANG Weifan , WANG Wei , HE Fengxiao , WANG Shixiong , XUE Yu , MA Qi , GAO Bingren ,  LIU Debin

Department of Cardiac Surgery, the Second Hospital of Lanzhou University, Lanzhou, 730030, P.R.China;

Corresponding author：

LIU Debin, Email: liudebin01@sina.com

Keywords：

Sun's procedure; endovascular stent-graft; debranching; Stanford type A aortic dissection

DOI：

10.7507/1007-4848.201810001

Video：

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Objective To analyze the near-term clinical efficacy of two different surgical procedures (Sun's procedure and Debranching combined endovascular stent-graft procedure) to cure Stanford type A aortic dissection, and summarize the clinical experience to help better master the indications of the two surgical procedures. Methods We retrospectively analyzed the clinical data of 46 patients with Stanford A aortic dissection in our hospital between September 2014 and September 2017. There were 39 males and 7 females at age of 20–74 (48.67±11.80) years. According to different surgical methods, the patients were divided into a Sun's procedure group (26 patients) and a debranching combined endovascular stent-graft procedure group (20 patients). The clinical effect of the two groups was compared. Results The debranching combined endovascular stent-graft procedure group was significantly superior to the Sun's group in cardiopulmonary bypass (CPB) time, aortic cross clamp(ACC) time, intraoperative urine output, postoperative mechanical ventilation time, postoperative 24 h volumes of drain, CICU time, renal function recovery of postoperative 72 h and total hospital stay(P<0.05). The incidence of transient neurological damage after operation in the debranching combined endovascular stent-graft procedure group was significantly lower than that of the Sun's procedure group(P<0.05). The follow-up time ranged from 3 to 36 months. And the follow-up rate was 90.5%. One patient in the Sun's procedure group died of serious pulmonary infection postoperative 30 days. One patient in the debranching combined endovascular stent-graft group was found to have internal leakage in the early postoperative examination and disappeared after 6 months. Sun's procedure group did not find endoleak. All patients during the follow-up time did not appear brain, coagulation disorders, stroke, paraplegia, upper limb ischemia and other complications. Conclusion For Stanford type A aortic dissection, debranching combined surgery may have the risk of postoperative endoleak, but the overall effect is superior to Sun's operation. Therefore, debranching combined surgery should be preferred for the treatment of this type of dissection.

Citation： ZHAO Yinglu, WANG Weifan, WANG Wei, HE Fengxiao, WANG Shixiong, XUE Yu, MA Qi, GAO Bingren, LIU Debin. Different surgical procedures for Stanford type A aortic dissection: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 664-669. doi: 10.7507/1007-4848.201810001 Copy

1.	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): 47-51.
2.	刘维永. 胸主动脉瘤及主动脉夹层外科治疗进展. 中国胸心血管外科临床杂志, 2003, 10(1): 50-53.
3.	Zink BJ. The biology of emergency medicine: what have 30 years meant for Rosen's original concepts? Acad Emerg Med, 2011, 18(3): 301-304.
4.	Griepp RB, Stinson EB, Hollingsworth JF, et al. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg, 1975, 70(6): 1051-1063.
5.	Harrington DK, Walker AS, Kaukuntla H, et al. Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: a prospective randomized trial. Circulation, 2004, 110(11 Suppl 1): I231-I236.
6.	Preventza O, Garcia A, Cooley DA, et al. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg, 2015, 150(6): 1591-1598.
7.	Coselli JS. Reflection of pioneers: redo thoracoabdominal aortic aneurysm repair controversies in thoracic aortic aneurysm surgery. Gen Thorac Cardiovasc Surg, 2019, 67(1): 168-174.
8.	Saari P, Biancari F, Ihlberg L, et al. Early and midterm outcomes after endovascular treatment of degenerative aneurysms of the descending thoracic aorta: a Finnish multicenter study. J Endovasc Ther, 2013, 20(3): 257-264.
9.	Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.
10.	Ishimaru S. Endografting of the aortic arch. J Endovasc Ther, 2004, 11(Suppl 2): I62-I71.
11.	Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S85-S90.
12.	Czerny M, Funovics M, Schoder M, et al. Transposition of the supra-aortic vessels before stent grafting the aortic arch and descending aorta. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S91-S97.
13.	Gehringhoff B, Torsello G, Pitoulias GA, et al. Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. J Endovasc Ther, 2011, 18(5): 650-655.
14.	Preventza O, Bakaeen FG, Cervera RD, et al. Deployment of proximal thoracic endograft in zone 0 of the ascending aorta: treatment options and early outcomes for aortic arch aneurysms in a high-risk population. Eur J Cardiothorac Surg, 2013, 44(3): 446-452.
15.	Black SA, Wolfe JH, Clark M, et al. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg, 2006, 43(6): 1081-1089.
16.	Hata M, Sezai A, Yoshitake I, et al. Clinical trends in optimal treatment strategy for type A acute aortic dissection. Ann Thorac Cardiovasc Surg, 2010, 16(4): 228-235.
17.	Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic system of patients with acute aortic dissection undergoing aortic arch surgery. Ann Thorac Surg, 2016, 101(3): 945-951.
18.	Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
19.	Shono Y, Akahoshi T, Mezuki S, et al. Clinical characteristics of type A acute aortic dissection with CNS symptom. Am J Emerg Med, 2017, 35(12): 1836-1838.
20.	Putanov MA, Sokolova MA, Lenkin PI, et al. Use of polypeptide neuroprotection for prevention of postoperative cognitive dysfunction after cardiac surgery: a pilot prospective randomized placebo-controlled clinical study. Circulation Pathol Card Surg , 2017, 21(4): 69-78.
21.	王柏春, 刘宗泓, 孟维鑫, 等. 不同体、脑灌注方式对Stanford A型主动脉夹层患者的脑保护研究. 中国胸心血管外科临床杂志, 2013, 20(5): 529-532.
22.	彭小乐, 王晓龙, 刘愚勇, 等. 温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响. 首都医科大学学报, 2015, 36(3): 364-370.
23.	Piffaretti G, Mariscalco G, Lomazzi C, et al. Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair. J Thorac Cardiovasc Surg, 2009, 138(4): 880-885.
24.	Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
25.	Patel HJ, Upchurch GR Jr, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.

1. 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): 47-51.
2. 刘维永. 胸主动脉瘤及主动脉夹层外科治疗进展. 中国胸心血管外科临床杂志, 2003, 10(1): 50-53.
3. Zink BJ. The biology of emergency medicine: what have 30 years meant for Rosen's original concepts? Acad Emerg Med, 2011, 18(3): 301-304.
4. Griepp RB, Stinson EB, Hollingsworth JF, et al. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg, 1975, 70(6): 1051-1063.
5. Harrington DK, Walker AS, Kaukuntla H, et al. Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: a prospective randomized trial. Circulation, 2004, 110(11 Suppl 1): I231-I236.
6. Preventza O, Garcia A, Cooley DA, et al. Total aortic arch replacement: A comparative study of zone 0 hybrid arch exclusion versus traditional open repair. J Thorac Cardiovasc Surg, 2015, 150(6): 1591-1598.
7. Coselli JS. Reflection of pioneers: redo thoracoabdominal aortic aneurysm repair controversies in thoracic aortic aneurysm surgery. Gen Thorac Cardiovasc Surg, 2019, 67(1): 168-174.
8. Saari P, Biancari F, Ihlberg L, et al. Early and midterm outcomes after endovascular treatment of degenerative aneurysms of the descending thoracic aorta: a Finnish multicenter study. J Endovasc Ther, 2013, 20(3): 257-264.
9. Melissano G, Civilini E, Bertoglio L, et al. Results of endografting of the aortic arch in different landing zones. Eur J Vasc Endovasc Surg, 2007, 33(5): 561-566.
10. Ishimaru S. Endografting of the aortic arch. J Endovasc Ther, 2004, 11(Suppl 2): I62-I71.
11. Bavaria J, Vallabhajosyula P, Moeller P, et al. Hybrid approaches in the treatment of aortic arch aneurysms: postoperative and midterm outcomes. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S85-S90.
12. Czerny M, Funovics M, Schoder M, et al. Transposition of the supra-aortic vessels before stent grafting the aortic arch and descending aorta. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S91-S97.
13. Gehringhoff B, Torsello G, Pitoulias GA, et al. Use of chimney grafts in aortic arch pathologies involving the supra-aortic branches. J Endovasc Ther, 2011, 18(5): 650-655.
14. Preventza O, Bakaeen FG, Cervera RD, et al. Deployment of proximal thoracic endograft in zone 0 of the ascending aorta: treatment options and early outcomes for aortic arch aneurysms in a high-risk population. Eur J Cardiothorac Surg, 2013, 44(3): 446-452.
15. Black SA, Wolfe JH, Clark M, et al. Complex thoracoabdominal aortic aneurysms: endovascular exclusion with visceral revascularization. J Vasc Surg, 2006, 43(6): 1081-1089.
16. Hata M, Sezai A, Yoshitake I, et al. Clinical trends in optimal treatment strategy for type A acute aortic dissection. Ann Thorac Cardiovasc Surg, 2010, 16(4): 228-235.
17. Guan XL, Wang XL, Liu YY, et al. Changes in the hemostatic system of patients with acute aortic dissection undergoing aortic arch surgery. Ann Thorac Surg, 2016, 101(3): 945-951.
18. Parikh N, Trimarchi S, Gleason TG, et al. Changes in operative strategy for patients enrolled in the International Registry of Acute Aortic Dissection interventional cohort program. J Thorac Cardiovasc Surg, 2017, 153(4): S74-S79.
19. Shono Y, Akahoshi T, Mezuki S, et al. Clinical characteristics of type A acute aortic dissection with CNS symptom. Am J Emerg Med, 2017, 35(12): 1836-1838.
20. Putanov MA, Sokolova MA, Lenkin PI, et al. Use of polypeptide neuroprotection for prevention of postoperative cognitive dysfunction after cardiac surgery: a pilot prospective randomized placebo-controlled clinical study. Circulation Pathol Card Surg , 2017, 21(4): 69-78.
21. 王柏春, 刘宗泓, 孟维鑫, 等. 不同体、脑灌注方式对Stanford A型主动脉夹层患者的脑保护研究. 中国胸心血管外科临床杂志, 2013, 20(5): 529-532.
22. 彭小乐, 王晓龙, 刘愚勇, 等. 温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响. 首都医科大学学报, 2015, 36(3): 364-370.
23. Piffaretti G, Mariscalco G, Lomazzi C, et al. Predictive factors for endoleaks after thoracic aortic aneurysm endograft repair. J Thorac Cardiovasc Surg, 2009, 138(4): 880-885.
24. Buth J, Harris PL, Hobo R, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) registry. J Vasc Surg, 2007, 46(6): 1103-1110.
25. Patel HJ, Upchurch GR Jr, Eliason JL, et al. Hybrid debranching with endovascular repair for thoracoabdominal aneurysms: a comparison with open repair. Ann Thorac Surg, 2010, 89(5): 1475-1481.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Different surgical procedures for Stanford type A aortic dissection: A case control study

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