Abstract:

Objective    To review surgical treatment of type A aortic dissection in 65 patients and to investigate the effectiveness of surgical approaches. Methods    Between September, 2003 and April, 2010, 65 patients,  including 45 males and 20 females from 26 to 58 (mean 41.6 ± 9.5) years old, with Stanford type A aortic dissection underwent surgical treatment. Different surgical approaches were adopted according to the rupture site, extent of dissection and aortic valvular insufficiency, including ascending aorta replacement only (10 cases), ascending aorta replacement + arch or semi-arch replacement (13 cases), ascending aorta replacement + arch or semi-arch replacement with stented elephant trunk (27 cases), ascending aorta replacement + four branches covered stent graft implantation (7 cases) and Bentall operation only (8 cases). Concomitant procedures were coronary artery bypass grafting (4 cases), aortic valvuloplasty(12 cases), aortic valve replacement(8 cases ) or Bentall operation (6 cases). Deep hypothermic circulation arrest with selective cerebral perfusion was employed in cases of aortic arch replacement and/or  endovascular stent repair. Results    In the operations, the CPB, clamp and circulation arrest time were 86 -350 (188.3±60.9), 60-248 (101.1±40.0)  and 20-120 (53.9±24.3) minutes, respectively. There were two deaths  early  after operation. Onedied from low cardiac output syndrome  and the other died from renal failure. Postoperative intensive care stay was 1~63 (4.2±8.8) days and the hospital stay was 13~106 (24.8±13.8) days. Complications  consisted of motor aphasia(n=1), cerebral embolism(n=1), pulmonary infection(n=3), renal failure(n=1), hemorrhage(n=5), mental disorder(n=4), tracheotomy (n=1), and voice hoarseness(n=1). Conclusion     Aortic dissection is the most common catastrophic event that involves the aorta, however, the prospects of early surgical treatment are satisfying.  The key points are quick, correct diagnosis and proper surgical approaches.

Key words: Aortic dissection; Stanford type A; Surgical treatment; Stented elephant trunk technique