ABSTRACT
Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion.Methods From January 2010 to November 2015,307 patients of acute Stanford A aortic dissection underwent operation were included.The mean age was (51.3 ± 13.0) years,ranged from 22 to 83.The BMI was (25.4 ± 3.7) kg/m2 and 239 (77.9％) were men.There were 210 (71.2％) with hypertension,9 (2.9％) with Marian syndrome,and 44 (14.3％) with cardiac tamponade.Coronary malperfusion was confirmed in 43(14.0％) patients with 34 in right coronary artery,5 in left coronary artery,and 4 in both.There were 26 type A,8 type B,9 type C in Neri system.We performed coronary ostia repair in 12 patients,Bentall in 16,coronary artery bypass grafting(CABG) in 9,and Bentall plus CABG in 6.CABG was also performed in 1 Bentall,1 aortic valve repair,and 5 ascending aorta replacement in 264 patients without coronary malperfusion.Results The rate of CABG,cardiopulmonary bypass(CPB) time,aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P ＜0.01).The in-hospital mortality was 32.6％ in patients with coronary malperfusion and 14.4％ in patients without coronary malperfusion.Thus,coronary malperfusion significantly increased in-hospital mortality(P ＜0.01).The mean follow-up time was(19.2 ± 18.0) months with a 95％ follow-up rate.The total follow-up survival rate is 97.5％ and the rate of patients with coronary malperfusion is 100％.Multivariate logistic regression analysis shows that cardiac tamponade(OR =4.8,P ＜0.01) and CPB time(OR =1.0,P ＜0.01) was the independent risk factor of post-operation inhospital mortality of acute Stanford A aortic dissection.Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly.The treatment strategy depends on the specific clinical condition.
ABSTRACT
Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.
ABSTRACT
Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.