Intraoperative single branch stent combined with modified bilateral cerebral perfusion for the treatment of type A aortic dissection: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Wei , ZHANG Chengxin , CHEN Tao , CHU Chenghao ,  GONG Wenhui

Department of Cardiac Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P. R. China;

Corresponding author：

GONG Wenhui, Email: gongwenhui18@163.com

Keywords：

Type A aortic dissection; bilateral cerebral perfusion; propensity score matching analysis; branched stent

DOI：

10.7507/1007-4848.202407048

Video：

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Objective To explore the clinical efficacy of single-branch intraoperative stent combined with modified bilateral cerebral perfusion in type A aortic dissection. Methods A retrospective analysis was conducted on the clinical data of patients who underwent surgery for type A aortic dissection at the First Affiliated Hospital of Anhui Medical University from January 2021 to May 2024. Patients were divided into the experimental group (single branch stent combined with modified bilateral cerebral perfusion) and the control group (traditional surgical method, straight stent+unilateral cerebral perfusion) according to the surgical method. Propensity score matching analysis was used to match the two groups of patients with a ratio of 1:1, and the perioperative data and clinical efficacy after matching were compared. Results A total of 14 patients were included in the experimental group, including 13 males and 1 female, with an average age of (47.4±16.1) years. There were 56 patients in the control group, including 38 males and 18 females, with an average age of (52.1±11.7) years. After propensity score matching, 14 patients were included in each group. Compared with the control group, the ventilator support time [(27.4±24.3) h vs. (93.4±88.0) h, P=0.018], length of stay in the intensive care unit [(2.8±1.8) d vs. (8.7±6.5) d, P=0.009], and postoperative awakening time [(5.4±2.2) h vs. (8.8±4.8) h, P=0.047] in the experimental group were shorter than those in the control group, with statistically significant differences. Conclusion Single-branch intraoperative stent combined with modified bilateral cerebral perfusion can effectively shorten ventilator support time, length of stay in the intensive care unit, and postoperative awakening time, and is safe and effective for the treatment of type A aortic dissection, which is worth further promotion.

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5.	刘宏宇, 孟维鑫, 孙博, 等. 急性StanfordA型主动脉夹层的治疗策略——2014年欧洲心脏病学会《主动脉疾病诊断和治疗指南》详细解读. 中华胸心血管外科杂志, 2015, 31(6): 321-324.Liu HY, Meng WX, Sun B, et al. Treatment strategies for acute Stanford type A aortic dissection—Detailed interpretation of the 2014 Aortic Disease Diagnosis and Treatment Guidelines of European Society of Cardiology. Chin J Thorac Cardiovasc Surg, 2015, 31(6): 321-324.
6.	徐思思, 钟芸. A型主动脉夹层体外循环术后神经系统并发症的研究进展. 中国体外循环杂志, 2022, 20(1): 44-48.Xu SS, Zhong Y. Research progress of neurological complications after extracorporeal circulation for type A aortic dissection. Chin J Extracorporeal Circ, 2022, 20(1): 44-48.
7.	Juraszek A, Czerny M, Rylski B. Update in aortic dissection. Trends Cardiovasc Med, 2022, 32(7): 456-461.
8.	Bossone E, Eagle KA. Epidemiology and management of aortic disease: Aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol, 2021, 18(5): 331-348.
9.	Yuan X, Mitsis A, Nienaber CA. Current understanding of aortic dissection. Life (Basel), 2022, 12(10): 1606.
10.	Yan Y, Zhang X, Yao Y, et al. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore), 2023, 102(39): e34668.
11.	Sheng W, Le S, Song Y, et al. Preoperative nomogram and risk calculator for postoperative hypoxemia and related clinical outcomes following Stanford type A acute aortic dissection surgery. Front Cardiovasc Med, 2022, 9: 851447.
12.	Zhou J, Pan J, Yu Y, et al. Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection. Ann Palliat Med, 2021, 10(7): 7388-7397.
13.	Dunham AM, Grega MA, Brown CH, et al. Perioperative low arterial oxygenation is associated with increased stroke risk in cardiac surgery. Anesth Analg, 2017, 125(1): 38-43.
14.	Sheng W, Le S, Song Y, et al. Preoperative nomogram and risk calculator for postoperative hypoxemia and related clinical outcomes following Stanford type A acute aortic dissection surgery. Front Cardiovasc Med, 2022, 9: 851447.
15.	Duan XZ, Xu ZY, Lu FL, et al. Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection. J Thorac Dis, 2018, 10(3): 1628-1634.
16.	Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
17.	Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-946.
18.	Ge M, Wang Z, Chen T, et al. Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey typeⅠaortic dissection repairment. J Thorac Dis, 2021, 13(2): 735-742.

1. Gouveia E Melo R, Mourão M, Caldeira D, et al. A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies. J Vasc Surg, 2022, 75(2): 709-720.
2. De Freitas S, Rossi MJ, Abramowitz SD, et al. Systematic review and meta-analysis of endovascular interventions for Stanford type A aortic dissection. J Vasc Surg, 2021, 74(5): 1721-1731.
3. Si Y, Duan W, Xie J, et al. Biomarkers for prediction of neurological complications after acute Stanford type A aortic dissection: A systematic review and meta-analysis. PLoS One, 2023, 18(2): e0281352.
4. Giambuzzi I, Mastroiacovo G, Roberto M, et al. Preoperative neurological dysfunctions: What is their meaning in patients presenting with acute type A aortic dissection? Minerva Cardioangiol, 2020, 68(5): 511-517.
5. 刘宏宇, 孟维鑫, 孙博, 等. 急性StanfordA型主动脉夹层的治疗策略——2014年欧洲心脏病学会《主动脉疾病诊断和治疗指南》详细解读. 中华胸心血管外科杂志, 2015, 31(6): 321-324.Liu HY, Meng WX, Sun B, et al. Treatment strategies for acute Stanford type A aortic dissection—Detailed interpretation of the 2014 Aortic Disease Diagnosis and Treatment Guidelines of European Society of Cardiology. Chin J Thorac Cardiovasc Surg, 2015, 31(6): 321-324.
6. 徐思思, 钟芸. A型主动脉夹层体外循环术后神经系统并发症的研究进展. 中国体外循环杂志, 2022, 20(1): 44-48.Xu SS, Zhong Y. Research progress of neurological complications after extracorporeal circulation for type A aortic dissection. Chin J Extracorporeal Circ, 2022, 20(1): 44-48.
7. Juraszek A, Czerny M, Rylski B. Update in aortic dissection. Trends Cardiovasc Med, 2022, 32(7): 456-461.
8. Bossone E, Eagle KA. Epidemiology and management of aortic disease: Aortic aneurysms and acute aortic syndromes. Nat Rev Cardiol, 2021, 18(5): 331-348.
9. Yuan X, Mitsis A, Nienaber CA. Current understanding of aortic dissection. Life (Basel), 2022, 12(10): 1606.
10. Yan Y, Zhang X, Yao Y, et al. Postoperative pulmonary complications in patients undergoing aortic surgery: A single-center retrospective study. Medicine (Baltimore), 2023, 102(39): e34668.
11. Sheng W, Le S, Song Y, et al. Preoperative nomogram and risk calculator for postoperative hypoxemia and related clinical outcomes following Stanford type A acute aortic dissection surgery. Front Cardiovasc Med, 2022, 9: 851447.
12. Zhou J, Pan J, Yu Y, et al. Independent risk factors of hypoxemia in patients after surgery with acute type A aortic dissection. Ann Palliat Med, 2021, 10(7): 7388-7397.
13. Dunham AM, Grega MA, Brown CH, et al. Perioperative low arterial oxygenation is associated with increased stroke risk in cardiac surgery. Anesth Analg, 2017, 125(1): 38-43.
14. Sheng W, Le S, Song Y, et al. Preoperative nomogram and risk calculator for postoperative hypoxemia and related clinical outcomes following Stanford type A acute aortic dissection surgery. Front Cardiovasc Med, 2022, 9: 851447.
15. Duan XZ, Xu ZY, Lu FL, et al. Inflammation is related to preoperative hypoxemia in patients with acute Stanford type A aortic dissection. J Thorac Dis, 2018, 10(3): 1628-1634.
16. Liu N, Zhang W, Ma W, et al. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2017, 24(2): 251-256.
17. Sheng W, Yang HQ, Chi YF, et al. Independent risk factors for hypoxemia after surgery for acute aortic dissection. Saudi Med J, 2015, 36(8): 940-946.
18. Ge M, Wang Z, Chen T, et al. Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey typeⅠaortic dissection repairment. J Thorac Dis, 2021, 13(2): 735-742.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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