Perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation / 中国综合临床

Objective To investgate the proper perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation. Methods A total of 56cases with Debakey Ⅰ aortic dissection were enrolled into the study and operated by new type of three branches aortic arch covered stent graft implantation from July 2009 to August 2010. Results The cardiopulmonary bypass time during the operation was 90. 0 -248.0 min( median time 180. 6 ains) ,aortic cross clamp time was 69. 0 - 180. 0 min(median time 108. 2 mins) ,circulation arrest time was 17.0 -37.0 min ( median time 22. 6mins) ,the time using reathing apparatus was 16.0 -260.0 hours (median time 42. 8 hours),ICU residence time was 3.0 -23. 0 days( median time 6. 6 days). Fifty-four patients got well and were discharged. One patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection.

Analysis of neurological complication after type DeBakey Ⅰ aortic dissection / 中国医师进修杂志

ObjectiveTo evaluate the risk factors and of neurological complications after type DeBakey Ⅰ aortic dissection. MethodsSeventy patients underwent operations of the aortic dissection with deep hypothermic circulatory arrest (DHCA) in combination with antegrade selective cerebral perfusion (ASCP). Perioperative factors were evaluated by means of univariate and multivariate logistic analysis to identify relative risk factors of neurological complications. ResultsOne case was exduded. The extracorporeal circulation time was (158.39 ±47.16) min,the aortic crossclamp time was (99.12 ±46.27) min,the brain stop circulation time was (29.83 ± 6.85 ) min. Neurological complications occurred in 19 patients (27.5％),including 10 patients with temporary cerebral dysfunction, 3 patients with permanent cerebral dysfunction, 2patients with paraplegia,4 patients with hoarseness. Renal and hepatic dysfunction, hypertension disease,aortic crossclamp time ＞ 120 min,circulatory arrest time ＞40 min, blood transfusion volume ＞4000 ml,arterial blood pressure instability ＞ 80 mm Hg ( 1 mm Hg = 0.133 kPa) and postoperative low cardiac output were the risk factors for cerebral complication (P ＜ 0.05 or ＜ 0.01 ). ConclusionsNo single risk factor explains the onset of neurological complications. Cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion does not influence the neurological complications. Protection of all the endorgans would be helpful to the cerebral protection.