Short and medium-term results of the use of aortic arch branch-prioritized reconstruction in Stanford type A aortic dissection

Wang Junhui; Chi Haitao; Yang Ming; Wang Zining; Dong Zhaorui; Chen Lei; Xue Yan; Zhao Qiang; Zheng Nan; Chen Tingting; Wang Cheng; Yang Ruidong; Dong Jie; Xiao Cangsong

doi:10.13498/j.cnki.chin.j.ecc.2024.01.07

Abstract：Objective To summarize the clinical experience of Stanford type A aortic dissection with non-extracorporeal circulation and priority reconstruction technique without interruption of cerebral blood supply,and to discuss the safety and reliability of its brain protection.Methods A retrospective analysis was performed on 17 Stanford Type A aortic dissection operations operated by priority reconstruction of partial branches of the arch in our center from June 2020 to March 2023,By transecting the innominate artery or the left common carotid artery,the arterial tube is reversely inserted into the aortic arch,and the branch vessels of the arch part are preferentially anastomosed with the four branch artificial vessels to ensure that the whole brain perfusion is completed before the lower body stops circulation.The surgical procedures included ascending aorta replacement + total arch replacement + descending aorta stent implantation and/or aortic root treatment in 17 cases(coronary artery bypass surgery was performed in 3 cases).Results All the 17 cases in the group were successfully completed,and there was no intraoperative death,no sternal incision or artificial blood vessel infection.There was no transextension of incision through small incision in upper sternal segment.The postoperative waking time was(4.23±0.73)h.1 patient died due to postoperative cerebral infarction and septic shock,and the other patients were cured and discharged from hospital without neurological complications.The other 16 patients were followed up by telephone at 3 months,6 months and 1 year after discharge,respectively,and the follow-up rate was 100%.None of the patients had death,cardiovascular complications,re-surgical intervention,new aortic dissection,aortic rupture,proximal retrograde tear,kidney disease,or brain disease.Conclusion It is safe and feasible to perform Stanford type A aortic dissection with priority reconstruction of arch without interruption of cerebral blood supply under non-extracorporeal circulation,which can give priority to cerebral perfusion and reduce the occurrence of early and middle postoperative neurological complications.