ObjectiveTo analyze the clinical outcomes of Cabrol procedure for the treatment of Stanford type A aortic dissection. MethodsClinical data of 37 patients with Stanford type A aortic dissection underwent Cabrol procedure at the Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute from January 2009 to April 2014 were retrospectively analyzed. There were 34 males and 3 females aged at 21 to 66 years. The average interval time from onset to getting operation was 15.2±28.5 days. All patients received Cabrol procedure was performed for aortic root. According to different aortic arch conditions, hemiarch replacement or total arch replacement combined endovascular aortic repair with stent were performed. ResultsAll the operations were successfully performed including isolated Cabrol procedure in 4 patients, right hemiarch replacement in 10 patients and total arch replacement combined endovascular aortic repair with stent in 23 patients. One patient (2.7%) underwent reexploration for postoperative bleeding. Postoperative mortality was 10.8% (4/37). Follow-up duration was 1-24 months, 2 patients died during follow-up. ConclusionCabrol procedure has satisfactory clinical outcomes for Stanford type A AD and long-term patency of aortic without coronary oppression.
Objective To analyze the surgical effect of total aortic arch replacement and stented elephant trunk (Sun’s procedure) for acute or chronic Stanford type A aortic dissection, and to investigate the optimal surgical timing for Stanford type A aortic dissection involving aortic arch. Methods We retrospectively reviewed the clinical data of 327 patients with acute or chronic Stanford type A aortic dissection treated by Sun's procedure from June 2010 to June 2014 in Guangdong Cardiovascular Institute. Patients were divided into two groups according to whether the time from onset to operation was longer than 2 weeks: an acute group with 229 patients (≤2 weeks, the average time of onset to operation 5.70±3.50 d) and a chronic group with 98 patients (>2 weeks, the average time of onset to operation 21.60±15.70 d). There were 186 males and 43 females with a mean age of 47.47±11.19 years in the acute group, and 76 males and 22 females with a mean age of 45.62±12.92 years in the chronic group. The patients discharged from hospital were followed up for one year. Results There was no significant difference between the two groups in preoperative data. The rate of coronary artery bypass grafting, cardiopulmonary bypass time, aortic cross-clamping time, intraoperative and postoperative 24 h red blood cell intake were higher or more in the acute group than those in the chronic group (P<0.05). The in-hospital morality, ICU stay, mechanical ventilation time, the incidence of neurological dysfunction, low cardiac output syndrome, acute renal failure with continuous renal replacement therapy, hepatic insufficiency, poor wound healing were higher or more in the acute group than those in the chronic group (P<0.05). During one year follow-up, the survival rate of the acute and chronic groups was 97.0% and 97.6% respectively (P>0.05). No new complications were found in the two groups. The irreversible neurological dysfunction, paraplegia and renal failure showed no significant difference between the two groups. Conclusion The short-term mortality and complications of acute Stanford A aortic dissection involving aortic arch treated by Sun’s procedure are significantly higher or more than those of chronic Stanford type A aortic dissection. The risk of surgical treatment in acute phase is high.
Objective To investigate the combined effects of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training for dysphagia in patients who underwent aortic arch surgery. Methods Forty-two consecutive patients with dysphagia after aortic arch surgery between October 2014 and November 2017 were divided into two groups including an observation group and a control group. There were 21 patients in each group. There were 17 males and 4 females at age of 51.0±6.5 years in the observation group, while 18 males and 3 females at age of 49.8±7.3 years in the control group. The patients in the observation group underwent electroacupuncture therapy and voice training (20 min per day for each therapy, 2 weeks), while the patients in the control group only received safe swallowing education and rehabilitation guidance (2 weeks). The test results, such as fibrolaryngoscope and functional oral intake scale (FOIS) score, and the data of computer phonatory detection, before and after the intervention were compared. Results The fibrolaryngoscope of vocal cords significantly decreased and the FOIS score significantly increased after digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training in the observation group(6.30 vs. 4.60, P<0.05). Bucking was obviously reduced. The indicators of hoarse degree, such as median pitch, fundamental frequency, jitter (0.60%±0.96%vs. 1.99%±1.86%, P=0.033), shimmer (2.47%±4.26% vs. 5.89%±3.66%, P=0.043), maximum phonation time (15.31±9.10 s vs. 3.72±8.83 s, P=0.006), maximum and loud phonation time (9.30±5.73 s vs. 2.32±2.99 s, P=0.039), mean noise-to-harmonics ratio (23.99±10.17 vs .9.98±9.37, P=0.006) and mean harmonics-to-noise ratio (0.03±0.02 vs. 0.17±0.23, P=0.019) improved after the treatment in both groups. But the improvement in the observation group was significantly better than that in the control group. Conclusion The combination of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training on dysphagia in patients who underwent aortic arch surgery can significantly improve the swallowing function of patients. Meanwhile, it also helps the recovery of phonic function and improves the ability of feeding and communication in these patients.
We conducted a detailed analysis of different hypothermic circulatory arrest techniques, from its evolution, application on aortic arch surgery and research, focusing on the application and advantages and disadvantage, which provides some guide for the future discussion on the optimal temperature of hypothermic circulatory arrest.
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.
Objective To retrospectively reviewed our experience of the surgical and perioperative treatment of patients suffering from critical Marfan syndrome with severe left ventricular dysfunction and to evaluate its therapeutic effect and prognosis. Methods Between January 2012 and October 2016, 15 patients diagnosed with Marfan syndrome combined with severe left ventricular dysfunction (left ventricular ejection fraction≤40% or left ventricular end diastolic diameter≥75 mm) underwent operations for aortic root aneurysm in Zhujiang Hospital and Guangdong General Hospital. Among them, 11 were males and 4 were females with a mean age of 32.9±8.7 years ranging from 19 to 55 years. Five patients with aortic dissection underwent Bentall procedure and total arch reconstruction with stent graft implantation. Two patients underwent Bentall procedure and hemi-arch replacement, seven patients underwent Bentall procedure and one patient underwent Cabrol procedure. Concomitant procedures included mitral valve repair in 12 patients, mitral valve replacement in 3 patients and tricuspid valve repair in 12 patients. Results There were 11 patients (73.3%) receiving intra-aortic balloon pumping implantation. One (6.7%) in-hospital death occurred. The left ventricular end diastolic diameter decreased from 80.5±7.4 mm to 58.3±6.0 mm (P<0.05) and the left ventricular ejection fraction improved from 37.3%±5.2% to 46.3%±4.4% 3 months postoperatively (P<0.05). The left ventricular end diastolic diameter decreased from 80.5±7.4 mm to 53.7±3.6 mm (P<0.05) and the left ventricular ejection fraction improved from 37.3%±5.2% to 57.7%±4.2% after one year (P<0.05). No death and reoperation occurred in the follow-up. Conclusion Although the patients with Marfan syndrome and severe left ventricular dysfunction usually have a high surgical mortality, the key to satisfactory outcomes of severe Marfan syndrome is adequate preoperative preparation, complete correction of all vascular lesions during the operation, application of circulatory auxiliary device and perioperative strict and long-term ICU monitoring.
ObjectiveTo evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection.MethodsFrom 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed.ResultsThe mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up.ConclusionLong FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.
ObjectiveTo assess whether expanding the landing zone of frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection. MethodsPatients with acute type A aortic dissection who were treated in Guangdong Provincial People’s Hospital from 2017 to 2020 were collected. They were divided into two groups according to the landing zone of FET by the image diagnosis of postoperative chest X-ray or total aorta CT angiography, including a Th9 group which defined as below the eighth thoracic vertebral level, and a Th8 group which was defined as above or equal to the eighth thoracic vertebral level. Using the propensity score matching (PSM) method, the preoperative and intraoperative data of two groups were matched with a 1∶2 ratio. The prognosis of the two groups after PSM was analyzed. Results Before PSM, 573 patients were collected, including 58 patients in the Th9 group and 515 patients in the Th8 group. After PSM, 174 patients were collected, including 58 patients in the Th9 group (46 males and 12 females, with an average age of 47.91±9.92 years), and 116 patients in the Th8 group (93 males and 23 females, with an average age of 48.01±9.53 years). There were 8 patients of postoperative spinal cord injury in the two groups after PSM, including 5 (4.31%) patients in the Th8 group and 3 (5.17%) patients in the Th9 group (P=0.738). In the Th8 group, 2 patients had postoperative transient paresis and recovered spontaneously after symptomatic treatment, and 1 patient had postoperative paraplegia with cerebrospinal fluid drainage. After 3 days, the muscle strength of both lower limbs gradually recovered after treatment. There was no statistical difference in complications between the two groups (P＞0.05). ConclusionExpanding the landing zone of FET does not increase the risk of spinal cord injury in patients with acute type A aortic dissection. However, the sample size is limited, and in the future, multicenter large-scale sample size studies are still needed for verification