Surgical treatment of Stanford A intramural hematoma
10.3760/cma.j.issn.1001-4497.2019.11.010
- VernacularTitle: Stanford A型主动脉壁间血肿的外科治疗
- Author:
Ningning LIU
1
;
Jindong LI
1
,
2
;
Longfei WANG
1
;
Zifan ZHOU
1
;
Jun WANG
1
;
Yongmin LIU
1
;
Junming ZHU
1
;
Lizhong SUN
1
Author Information
1. Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
2. Deparctment of Cardiac Surgery, Liaocheng People Hospital , Liaochen 252000, China
- Publication Type:Journal Article
- Keywords:
Aortic intramural hematoma;
Surgical procedures;
Cardiopulmonary bypass;
Sun'
s procedure
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2019;35(11):684-687
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize experience and result in surgical treatment of Stanford type A intramural hematoma.
Methods:60 patients with Stanford type A intramural hematoma were operated from February 2015 to August 2017. Surgery was indicated in complicated cases with penetrating ulcer or ulcer-like projection in ascending aorta, maximum aorta diameter≥50 mm, progressive maximum aortic wall thickness≥10 mm, pericardial or pleural effusion, persistent or recurrent pain. Aortic valve regurgitation. In our group, 46 patients recieved ascending aorta replacement+ Sun' s procedure. 6 patients recieved Bentall+ Sun' s procedure. 4 patients recieved asceding aorta+ hemiarch replacement. 2 patients recieved Bentall+ hemiarch replacement. 2 patients recieved asceding aorta replacement.
Results:In the whole group, there was 1(1.7%)operative death because of multiple organ failure after operation. Hyoxemiaoccured in 5(8.3%) patients, 2(3.3%) patients occurred new renal failure and required CRRT treatment, cerebrovascular complication occurred in 1 (1.7%)patient, re-sternotomy due to bleeeding occured in 1 (1.7%)patient and paraplegia occured in 1(1.7%) patient after operation. but they recoved quickly after proper treatment. During follow up period, there were 4 cases need reintervention, including TEVAR for type B dissection at 3 months and distal stent-graft new entry at 1 year. Two other reinterventions were performed for endoleak by interventional occlusion. During the follow-up, hematoma absorption rates after treatment 1、3 and 6 months were 68.6%, 84.7% and 94.8%.
Conclusion:Given the dynamic evolution of acute type A IMH pre-operative accurate indications and the proper surgical strategy maybe the keys for success.
