Early and mid-term results of type Ⅱ hybrid arch repair with zone 0 stent graft deployment for acute type A aortic dissection
10.3760/cma.j.cn112434-20191009-00347
- VernacularTitle:杂交全主动脉弓修复术治疗急性Standford A型主动脉夹层早中期疗效分析
- Author:
Jiawei QIU
1
;
Shen LIU
;
Jinlin WU
;
Juntao QIU
;
Rui ZHAO
;
Xiaogang SUN
;
Cuntao YU
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院血管外科中心，北京 100037
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2020;36(5):273-277
- CountryChina
- Language:Chinese
-
Abstract:
Objective:By analyzing the early- and mid-term clinical results of type Ⅱ hybrid aortic arch repair(HAAR) for the treatment of acute type A aortic dissection(ATAAD), the efficacy of hybridization technique in the application of acute type A aortic dissection was evaluated systematically.Methods:We retrospectively studied the records of patients with ATAAD who were admitted to the Beijing Fuwai Hospital between January 2016 and December 2018. 504 patients were included for analysis , 383 men and 121 women, mean age(50.0±11.7) years, the rate of hypertension was 79.6%, the average time of onset to operation was(69.5±40.0) hours. During this period, 110 continuous patients underwent hybrid aortic arch repair(HAAR) without deep hypothermic circulatory arrest, the landing zone of stent was located in ascending aorta(zone 0); 394 consecutive patients with ATAAD involving the aortic arch received traditional total aortic arch replacement with frozen elephant trunk(FET). A propensity score-matching analysis was applied to adjust for age and gender.The preoperative, perioperative and postoperative data in the HAAR group and FET group were compared.Results:For all 504 patients , male patients accounted for 75.9%. There were 24 cases of early death(4.8%), 20 cases of stroke(4.0%) and 7 cases of paralysis(1.4%). HAAR group showed more age[(62.1±6.8) years vs (46.6±10.4) years, P<0.001)], hypertension(87.3% vs 77.4%, P=0.033), coronary artery disease(13.6% vs 6.1%, P=0.016) and chronic obstructive pulmonary diseases(12.7% vs 3.6%, P=0.001) than the FET group. HAAR group showed shorter cardiopulmonary bypass time[(143.7±53.7) min vs (175.3±52.7) min, P<0.001] and aortic cross-clamping time[(78.5±33.6) min vs (106.9±37.8) min, P<0.001] than the FET group. Between the two groups there was no significant difference in operative mortality, rate of reoperation, and late mortality. Follow-up period ranged from 2 to 43 months, averaged(22.6±11.1) months. During folloe-up period , there were 5 cases of death(4.9%) and 3 cases of reoperation(3.1%) in HAAR group, 10 cases of death(2.7%) and 11 cases of reoperation(3.3%) in FET group. 3 patients lost follow-up because of not been rechecked in the outpatient department or the phone was not connected. Conclusion:This single -stage hybrid arch procedure offers an alternative approach to acute type A dissection and associated with acceptable early and midterm major morbidity and mortality in old-age patients. Future further researches are required to confirm the long-term outcomes.
