Surgical treatment of Stanford type A acuteaortic dissection in elderly patients / 西安交通大学学报(医学版)

ABSTRACT

Objective To review our surgical treatment experience and analyze the surgical methods and efficacy of Stanford type A acute aortic dissection in elderly patients.Methods We recruited 24 patients aged over 60 years with Stanford type A acute aortic dissection treated surgically with deep hypothermic circulatory arrest and selective cerebral perfusion from June 2013 to September 2016.Depending on the patients` conditions, we selected different surgical methods, including Bentall operation in 3 cases, David operation in 1 case, partial aortic arc replacement+Bentall operation in 3 cases, total aortic arch replacement+stented elephant trunk implantation technique+Bentall operation in 12 cases, total aortic arch replacement+stented elephant trunk implantation technique+ascending aorta replacement in 5 cases, and concomitant coronary artery bypass grafting (CABG) in 3 cases.Results Surgical operation was successful in all the 24 patients.The average CPB time of the all patients was (192.9±37.1)min, the aortic cross-clamp time was (120±28.72)min, deep lower temperature of cerebral perfusion time was (36.2±11.3)min, and operation time was (544.8±91.2)min.Soon after the operation, two patients died of multiple organ dysfunction syndrome and renal failure complicated with infection, respectively.Postoperative complications included brain nerve dysfunction in 2 cases;renal insufficiency in 4 cases, which werelater treated with CRRT;pulmonary infection and tracheotomy in 3 cases;dysfunction in lower extremities in 1 case;hyoxemia in 3 cases;and incision infection in 2 cases.All the patients were followed up for 2-38 months, one patient was hospitalized because of hydropericardium and another one died of sudden death with unclear cause.Conclusion Surgical treatment of Stanford type A acute aortic dissection can obviously decrease the mortality and improve the quality of life.Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is a classic clinical surgical treatment.Precise diagnosis, suitable surgical treatment and post-operative care are all important factors contributing to patients` recovery.