Objective To investigate the surgical treatment and results of coronary malperfusion due to acute Stanford A aortic dissection. Methods The clinical data of 56 patients with coronary malperfusion due to type A aortic dissection, who were hospitalized and underwent operation between January 2009 and December 2016, were analyzed retrospectively. There were 39 males and 17 females at age of 26–73 (51.36±16.47) years. Results The right coronary artery was involved in 48 patients, the left in 5 patients, and both coronary arteries in 3 patients. There were 12 patients with coronary bypass grafting, 19 patients with Cabrol’s operation, 25 patients coronary artery plasty. Twelve patients died postoperatively at mortality of 21.4%. Forty-four patients survived. The patients were followed up for 3 months to 3 years. No adverse event of cardiovascular happened. Conclusion Stanford A aortic dissection with coronary involvement is associated with high mortality rate.Aggressive coronary revascularization is essential to salvage these critically ill patients. The method to reconstruct the involved coronary depends on the patients’ condition and experience of surgeon.
目的 总结法洛四联症矫治术的临床经验，进一步提高治愈率，降低其并发症和死亡率。 方法 回顾性分析2005年4月1日至2013年3月31日河南省胸科医院704例行法洛四联症矫治术患者的临床资料，其中男394例、女310例，年龄3个月至45岁，平均（3.6±6.6）岁。 结果 684 （97.20%） 例治愈，死亡20例，死亡率2.8%。死于低心排血量综合征和多器官功能衰竭16例，急性肾功能衰竭2例，术后灌注肺合并肺部感染1例，心搏骤停1例。因术后出血量多，再次开胸止血21例（2.98%）；脱离呼吸机后二次气管内插管21例（2.98%），腹膜透析治疗肾功能不全25例，发生感染性心内膜炎10例，Ⅲ°房室传导阻滞2例；10例术后出院前复查发现小的室间隔缺损残余漏，5例跨肺动脉瓣压差超过40 mm Hg。随访1～8年，随访到658例，随访率98%。随访期间因心衰死亡3例，因心内膜炎死亡1例。 结论 术前精确诊断，把握好手术适应证，术中矫治满意，术后及时恰当处理是手术成功的关键。
Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion. Methods From December 2012 to December 2016, 39 patients were diagnosed as acute type-A aortic dissection complicated with lower limb malperfusion and underwent operation.There were 27 males and 12 females with an average age of 51.4±12.4 years. Results Early mortality rate was 17.9%(7/39). 32 patients of postoperative survival. The follow-up rate was 93.8%(30/32), 3 months to 3 years after the operation, the results is satisfactory. The over lower limb malperfusion recovery rate of follow-up patients was 96.7%(29/30). Conclusion Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe, feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient’s status is strongly recommended for optimal surgical decision making.
ObjectiveTo evaluate the results of a hybrid procedure for treating Stanford type B1C aortic dissection.MethodsIn our center, 49 patients with Stanford type B1C aortic dissection underwent supra-arch branch vessel bypass and thoracic endovascular aortic repair (TEVAR) from December 2013 to December 2017. There were 33 males and 16 females with an average age of 60.4±5.5 years. Left common carotid artery to left subclavian artery bypass (n=29), right common carotid artery to left common carotid artery and left subclavian artery bypass (n=18), left common carotid artery to left subclavian artery and right common carotid artery to right subclavian artery bypass (n=2) were performed.ResultsEarly mortality rate was 2.0% (1/49). Forty-eight patients survived postoperatively. The follow-up rate was 100.0% (48/48). The patients were followed up for 6 to 47 (26.8±11.9) months postoperatively. Chest pain relapsed in one patient 8 months after the operation. The whole aorta CTA showed type A1S aortic dissection in one patient 6 months after the operation, and the re-operation was satisfactory. There was no endoleak or paraplegia.ConclusionInitial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for type B1C aortic dissection.
ObjectiveTo investigate the application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection.MethodsWe screened 183 patients with acute type A aortic dissection from January 2017 to January 2020 in our hospital. They were divided into 2 groups according to the cannulation strategy: ascending aorta cannulation and brachiocephalic trunk cannulation (a DAC group, n=42, 33 males and 9 females with a median age of 50 years) and the single axillary artery cannulation (an AAC group, n=141, 116 males and 25 females with a median age of 51 years). The general clinical data, intraoperative data and early postoperative results of the two groups before and after matching with propensity scores were compared.ResultsBefore propensity-score matching, the operation time, cardiopulmonary bypass time, aortic occlusion time and ICU stay in the DAC group were all shorter than those in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications, renal failure and pulmonary complications in the DAC group were significantly lower than those in the AAC group. After propensity-score matching, the operation time in the DAC group was significantly shorter than that in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications and pulmonary complications in the DAC group were significantly lower than those in the AAC group.ConclusionAscending aorta cannulation and brachiocephalic trunk cannulation can provide a safe, fast and effective method of establishing cardiopulmonary bypass for some acute type A aortic dissection patients, and significantly shorten the operation time without increasing surgical complications.
ObjectiveTo summarize the clinical experience in the treatment of high-risk patients with severe aortic valve disease by transcatheter aortic valve implantation (TAVI) via heart apex approach and to evaluate the early efficacy.MethodFive patients who underwent TAVI via heart apex approach from September 2017 to February 2019 in Henan Thoracic Hospital were retrospectively analyzed, including 3 males and 2 females, aged 65-84 (74.6±4.5) years.ResultAll operations were performed through a small left incision into the thoracic cavity (3-5 cm), and then through the J-Valve transport system, the aortic valve was successfully released via heart apex after precise positioning under digital subtraction angiography. One patient developed ventricular fibrillation during the operation, and the operation was completed with the assistance of emergency femoral arteriovenous catheterization cardiopulmonary bypass; one patient underwent percutaneous coronary intervention first because of severe coronary stenosis; one patient had paroxysmal atrial fibrillation during the perioperative period, and had hepatorenal insufficiency and thrombocytopenia after the operation, and was improved after medical treatment; one patient had perivalvular leak during the operation, and was improved after re-implantation of the valve; one patient was in stable condition during operation and recovered smoothly after operation. Surgery was successful in all 5 patients. The follow-up time was 2-19 months, and the early clinical effect was good.ConclusionThe short-term clinical efficacy of TAVI via heart apex approach in the treatment of high-risk severe aortic valve disease is definite and safe, but the long-term and medium-term effects need to be further evaluated.