Sun's procedure for type A aortic dissection involving aortic arch after Bentall / 中华胸心血管外科杂志

ABSTRACT

Objective Stanford type A aortic dissection(TAAD) involving aortic arch in following prior Bentall procedure in patients with Madfan syndrome(MFS) is uncommon.The purpose of the study was to assess the early and long-term outcomes of this kind of patients underwent total arch replacement and frozen elephant trunk (TAR + FET).Methods Between February 2009 and February 2016,141 patients with Marfan syndrome(confirmed by revised Ghent Criteria) underwent TAR + FET for TAAD,of those 11 (7.8 ％) patients (8 acute) following a prior Bentall procedure and without dissection in distal aorta.Mean age at FET was(43.2 ± 8.6) years and 10 were males.Hypertension was seen in 4 (36.4％) and family history was seen in 7 (63.6％).The interval from Bentall procedure to FET averaged (11.3 ± 5.8) years.Two groups were segregated by the maximal diameter of descending aorta more than 40 mm or not.The early and long-term outcomes were analyzed and risk factors identified for late adverse events.Results Operative mortality was 27.3 ％ (3/11).No spinal cord injury occurred.The cause of death was long time of surgery,multiorgan failure,stroke and cerebral hemorrhage and rupture of distal aorta.Follow-up was complete in 100％,averaging(5.3-± 2.0)years(range 2.1-8.1 years).Obliteration of the false lumen was seen in 100％ across the proximal FET and 75.0％ in the unstented descending aorta.Distal aortic dilation occurred in 3 patients which were waiting open thoracoabdominal aortic repair(TAAAR) but no reoperation yet.Of those 8 patients,2 died of non-cardiac reason.The DMax of FET segment has significant grow in DA more than 40ram group than less than 40mm group (P =0.01).Another segment of distal aorta has no significant different.Survival were 81.8％,72.7％ and 63.6％ at 1 month,1 year and 6 years after surgery.Conclusion Using Sun's procedure for Marfan patients for type A aortic dissection involving aortic arch following previous Bentall procedure was safe and technically feasible with good long-term outcomes,but higher early death.The DMax of descending aorta more than 40mm was at higher risk for early death,late distal aortic dilation,and reoperation.