Midterm clinical results of Sun's procedure with median resternotomy
10.3760/cma.j.cn112434-20220406-00103
- VernacularTitle:再次正中开胸的孙氏手术近中期临床结果
- Author:
Ningning LIU
1
;
Yipeng GE
;
Jun ZHENG
;
Xiaolong WANG
;
Tao BAI
;
Chengnan LI
;
Zhiyu QIAO
;
Haiou HU
;
Yongmin LIU
;
Junming ZHU
;
Lizhong SUN
Author Information
1. 首都医科大学附属北京安贞医院 北京市心肺血管疾病研究所 北京市大血管疾病诊疗中心 北京市大血管外科植入式人工材料工程技术研究中心 主动脉外科中心，北京 100029
- Keywords:
Aortic diseases;
Median resternotomy;
Total aortic arch replacement;
Frozen elephant trunk technique
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(2):71-76
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical data of Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex aortic arch disease after previous cardiac surgery.Methods:From January 1, 2018 to December 31, 2020, a total of 55 patients underwent resternotomy Sun's procedure in the Aortic Surgery Center of Beijing Anzhen Hospital, including 41 males and 14 females, with a mean age of(45.4±12.7) years old, were retrospectively analyzed. The indications of primary cardiac surgery included type A aortic dissection, aortic root or ascending aortic aneurysm, heart valve surgery, and coronary heart disease. Indications for reoperation included residual aortic dissection larger than 55 mm in diameter, aortic aneurysm dilation, new type A aortic dissection, anastomotic leakage with symptoms, and pseudoaneurysm. All the operations were performed under general anesthesia and median resternotomy, total aortic arch replacement with the stented elephant trunk implantation and were performed by anterograde unilateral or bilateral cerebral perfusion.Results:There was no intraoperative death, and the postoperative mortality was 9.1%(5/55). The causes of death were 2 cases of low cardiac output, 1 case of respiratory failure, 1 case of cerebral complications, and 1 case of gastrointestinal bleeding. Except death, there were 2 cases of postoperative cerebral complications(2/50, 4%), 5 cases of spinal cord injury(transient paraplegia)(5/50, 10%), the median duration of ventilator use was 17 hours(14-42 h). Other postoperative complications included respiratory insufficiency requiring ventilatory support longer than 48 hours(8/50, 16%), renal insufficiency requiring temporary dialysis(2/50, 4%). The follow-up time was(25.9±11.2) months(10-47 months), during which 1 case died due to cerebral complication, 4 cases underwent total thoracoabdominal aorta replacement, and 1 case underwent anastomotic leakage repair.Conclusion:It is safe and effec to perform Sun's procedure(total aortic arch replacement with frozen elephant trunk technique) in the treatment of complex arch disease after previous cardiac surgery.
