Repair of Acute Type A Dissection: Our Experiences and Results

摘要

Patient DataSubclassification of Acute Type A DissectionSubtype of the aortic root (dependent upon the severity of aortic root lesions; Fig 1)Subtype of the distal aorta (dependent upon the extent and extension of aortic dissection extending beyond the ascending aorta and arch)Surgical TechniqueResultsSurgical DataMorbidity and MortalityFollow-UpSignificant advances in the diagnosis and therapy have greatly improved surgical outcomes of acute type A dissection. However, surgical management of acute type A dissection still poses formidable challenges, particularly in “developing” countries. We present our surgical management strategy of acute type A dissection in a single center in China.MethodsOn the basis of Stanford classification, acute type A dissection was subclassified at our center. Aortic root lesions were divided into three subtypes (A1, A2, and A3) and distal aortic lesions into two subtypes (C and S) according to lesion severity. The corresponding surgical procedure was scheduled according to each subtype. According to this subclassification, 257 patients (67 females, 190 males) with acute type A dissection underwent surgical treatment from January 2003 to March 2008.ResultsThe overall prevalence of in-hospital death was 4.67% (12 of 257) and deaths at follow-up were 3.27% (8 of 245) during a follow-up of 35 months. Stroke occurred in five patients, paraplegia in two patients, paraparesis in two patients, respiratory failure in 15 patients, renal failure in two patients, hepatic failure in one patient, and multiple-organ failure in one patient. Injury to the spinal cord and visceral organ ischemia were not observed in patients who underwent stented elephant trunk implantation during follow-up. Six patients underwent late distal aortic reoperation.ConclusionsThe encouraging and satisfactory surgical outcomes and postoperative results demonstrating a low prevalence of morbidity and mortality showed the substantial improvement in surgery for acute type A dissection using our surgical strategy at a center in China.CTSNet classification:26Acute type A dissection remains an intractable problem. Complete resection of the intimal tear and reapproximation of the proximal and distal edges of the dissected aorta are the primary objectives of surgery. However, the diseased dissected aortic wall is often left proximal and distal to the replaced aortic segment. Late proximal and distal reoperation after surgery for acute type A dissection has been frequently reported [