急性Stanford A型主动脉夹层的外科治疗_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIU Zhibing , CHEN Xin , XU Ming

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Research Institute, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, P.R.China. E-mail: qiuzhibingjs@yahoo.com.cn;

Corresponding author：

Keywords：

Aortic dissection; Surgical operation; Acute; Prosthetic vessel replacement

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Objective To investigate the surgical experience, best timing of operative intervention, technique and clinical effects of surgical treatment for acute Stanford type A aortic dissection. Methods The clinical material, method of operation and follow-up results were retrospectively reviewed for 29 patients with acute Stanford type A aortic dissection in latest 8 years. The main principle of surgical therapy in Stanford type A aortic dissection was resecting the partial aorta of intimal tear to prevent aortic rupture, repairing the intimal tear and replacing or reconstructing the aorta by composite graft, and simultaneously dealing with the heart valve and myocardial ischemia disease. Results Emergency surgery was performed in 13 cases, and sub-emergency surgery for 16 cases. There were 2 cases (69%) early postoperative death. One patient died of severe arrhythmia after emergency surgery, and another case died of multiorgan failure after operation. After operation 6 cases needed to be re-operated for bleeding, 3 cases developed lung infection and respiratory failure, 4 cases delayed waking, 2 cases occurred acute renal failure and one case occurred gastrorrhagia, they all were treated appropriately and recovered. Twenty-four cases? (889%) were followed up for 23.6±101 months. One case died after 16 months postoperatively due to endocarditis and cerebral hemorrhage. One case was recorded of sudden death in 26 months. Currently other patients were still healthy as the normal person. Conclusion Early-time surgical treatment is the key factor for acute Stanford type A aortic dissection to reduce the mortality. Procedures chosen must depend on the location of intimal tear, involved extension, and the condition of aortic valve and aortic root. It is principle as simplifying operation and good effects of treatment.

Citation： QIU Zhibing,CHEN Xin,XU Ming,SHI Kaihu,JIANG Yingshuo,WANG Liming,XIAO Liqiong,GUO Zhihuang. 急性Stanford A型主动脉夹层的外科治疗. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(6): 426-. doi: Copy

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2.	Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283 (7) :897-903.
3.	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.
4.	Fuster V, Ip JH. Medical aspects of acute aortic dissection. Semin Thorac Cardiovasc Surg, 1991,3(3):219-224.
5.	Trimarchi S, Nienaber CA, Rampoldi V,et al. contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
6.	Dossche KM,Schepens MA, Morshuis WJ, et al. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg, 1999,67(6):1904-1921.
7.	Langer F, Aicher D, Kissinger A, et al. Aortic valve repair using a differentiated surgical strategy. Circulation, 2004,110(11 Suppl 1):II67-II73.
8.	Halstead JC, Spielvogel D, Meier DM,et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications Eur J Cardiothorac Surg,2005,27(4):626-632.
9.	石应康，张尔永，田子朴,等. 升主动脉和弓部动脉瘤的外科治疗. 中国胸心血管外科临床杂志， 2003, 10 (1) : 6-8.
10.	Schepens MA, Dossche KM, Morshuis WJ, et al. The elephant trunk technique: operative results in 100 consecutive patients. Eur J Cardiothorac Surg,2002,21(2):276-281.
11.	Shiono M, Hata M,Sezai A,et al. Emergency surgery for acute type a aortic dissection in octogenarians. Ann Thorac Surg, 2006,82(2):554-559.
12.	张尔永，石应康，田子朴,等. A型主动脉夹层动脉瘤的外科治疗.中国胸心血管外科临床杂志， 2002, 9 (4) : 251-253.

1. 　Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A.Ann Thorac Surg, 2002,73(3):714-718.
2. 　Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA, 2000, 283 (7) :897-903.
3. 　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.
4. 　Fuster V, Ip JH. Medical aspects of acute aortic dissection. Semin Thorac Cardiovasc Surg, 1991,3(3):219-224.
5. 　Trimarchi S, Nienaber CA, Rampoldi V,et al. contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg, 2005, 129(1): 112-122.
6. 　Dossche KM,Schepens MA, Morshuis WJ, et al. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg, 1999,67(6):1904-1921.
7. 　Langer F, Aicher D, Kissinger A, et al. Aortic valve repair using a differentiated surgical strategy. Circulation, 2004,110(11 Suppl 1):II67-II73.
8. 　Halstead JC, Spielvogel D, Meier DM,et al. Composite aortic root replacement in acute type A dissection: time to rethink the indications Eur J Cardiothorac Surg,2005,27(4):626-632.
9. 　石应康，张尔永，田子朴,等. 升主动脉和弓部动脉瘤的外科治疗. 中国胸心血管外科临床杂志， 2003, 10 (1) : 6-8.
10. 　Schepens MA, Dossche KM, Morshuis WJ, et al. The elephant trunk technique: operative results in 100 consecutive patients. Eur J Cardiothorac Surg,2002,21(2):276-281.
11. 　Shiono M, Hata M,Sezai A,et al. Emergency surgery for acute type a aortic dissection in octogenarians. Ann Thorac Surg, 2006,82(2):554-559.
12. 　张尔永，石应康，田子朴,等. A型主动脉夹层动脉瘤的外科治疗.中国胸心血管外科临床杂志， 2002, 9 (4) : 251-253.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

急性Stanford A型主动脉夹层的外科治疗

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