Arch-clamping technique for surgical repair of acute Type A aortic dissection
10.3760/cma.j.cn112434-20210524-00178
- VernacularTitle:弓部阻断技术治疗急性A型主动脉夹层
- Author:
Fucheng XIAO
1
;
Yipeng GE
;
Chengnan LI
;
Zhiyu QIAO
;
Hai’ou HU
;
Junming ZHU
Author Information
1. 首都医科大学附属北京安贞医院心血管外科 北京市心肺血管疾病研究所 北京市大血管疾病诊疗研究中心，北京 100029
- Keywords:
Acute Type A Aortic Dissection;
Sun’s Procedure;
Arch-clamping
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(4):215-218
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy of arch-clamping technique in Sun’s procedure to repair acute type A aortic dissection.Methods:20 consecutive patients[17 males with mean age of (49.7±10.9)years old] with acute type A aortic dissection who underwent total arch replacement and frozen elephant trunk implantation (TAR+ FET) from May 2019 to April 2020 were divided into group with using arch-clamping technique during operation (arch-clamping group) or group without (traditional group). Circulatory arrest time, cardiopulmonary bypass time, recovery time, ventilation time, platelet count during the first 3 days postoperatively, blood loss during the first 12 h postoperatively, death, cerebral infarction and acute renal failure were compared. Patients with advanced age(age>70 years old ), or malperfusion syndrome preoperatively or who did not receiving TAR+ FET surgery were excluded from this study.Results:Circulatory arrest time[(4.1±0.6 )min vs. (17.2±2.6)min, P=0.001] and cardiopulmonary bypass time[(158.4±6.8 )min vs. (198.2±12.6)min, P=0.01] were significantly lower in arch-clamping group, compared with traditional group. Postoperative recovery time[(8.9±2.6 )h vs. (16.0±7.3)h, P=0.94] and ventilation time[(13.6±2.2)h vs. (34.1±14.3)h, P=0.18] were non significantly lower in arch-clamping group. Although postoperative platelet counts were higher in arch-clamping group during the first three days, those difference did not reach statistical significance ( P>0.05). All patients were discharged alive. There was no significant difference among the two group with respect to drainage during the first 12 h postoperatively, death, cerebral infarction and acute renal failure. Conclusion:Arch-clamping technique decrease circulatory arrest time dramatically and provide good protection of brain, coagulation and renal function by shortening ischemia time, thereby reducing postoperative complications. It is a safe and feasible innovative approach to effectively improve surgical outcome of Sun’s procedure for repair of acute type A aortic dissection.
