Surgical treatment strategy for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries
10.3760/cma.j.cn112434-20240709-00169
- VernacularTitle:急性A型主动脉夹层合并颈动脉重度狭窄或闭塞的外科治疗策略
- Author:
Jianji WANG
1
;
Runqiao LI
;
Jiazhen MEI
;
Yongliang ZHONG
;
Yu XIA
;
Chengnan LI
;
Zhiyu QIAO
;
Haiou HU
;
Yipeng GE
;
Junming ZHU
Author Information
1. 北京市心肺血管疾病研究所 首都医科大学附属北京安贞医院主动脉疾病诊疗中心，北京 100029
- Keywords:
Acute type A aortic dissection;
Carotid artery occlusion;
Carotid artery replacement surgery;
Surgical strategy
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2024;40(11):660-663
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore surgical strategies for acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries.Methods:From January 2019 to March 2023, a total of 29 patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries were included in the study. All patients underwent emergency surgery, with simultaneous intraoperative neck incision and replacement of the unilateral or bilateral carotid arteries. Among them, there were 19 males with a mean age of(49.57±2.14)years old. Preoperative brain CT indicated abnormalities in 15 cases, transient neurological dysfunction occurred in 5 cases, and syncope in 1 case.Results:Procedures included ascending aorta replacement in 10 cases, Bentall procedure in 18 cases, and Wheat procedure in 1 case. Arch operations involved partial arch replacement in 3 cases and Sun’s procedure in 26 cases. Simple left carotid artery replacement was performed in 6 cases, simple right carotid artery replacement in 19 cases, and bilateral carotid artery replacement in 4 cases. Cerebral protection measures during circulatory arrest included unilateral cerebral perfusion in 24 cases and bilateral cerebral perfusion in 5 cases. The mean operation time was(7. 6±0. 3) h, with a mean cardiopulmonary bypass time of(196. 3±8. 7) min, aortic cross-clamp time of(113.2±6.4) min, ischemic time 12(5-16.5) min, and lowest temperature of(26.3±0.4)°C. One patient experienced in-hospital mortality. Postoperatively, new neurological dysfunction occurred in 2 cases, including 1 case with coma and permanent neurological deficit.Conclusion:In patients with acute type A aortic dissection involving severe stenosis or occlusion of the carotid arteries, simultaneous carotid artery replacement via neck incision during aortic surgery is a safe and reliable surgical approach.
