Effectiveness and safety of total arch replacement with selective brain perfusion and stented elephant trunk technique with priority anastomosis of the aortic arch branches in the treatment of stanford type A aortic dissection
LI Xing
JIA Ya-nan
WANG Xue-xia
GUO Li-xin
Abstract：Objective To analyze the effectiveness and safety of total arch replacement with selective brain perfusion and stented elephant trunk technique with priority anastomosis of the aortic arch branches in the treatment of Stanford Type A aortic dissection.Methods 100 patients with Stanford type A aortic dissection admitted to Xingtai Central Hospital from August 2020 to May 2023 were selected and divided into the observation group and control group according to the random envelope method,each with 50 cases.The observation group was treated with total arch replacement with stenting and elephant nose operation with preferential anastomosis to the branches of the aortic arch,and the patients in the control group were treated with aortic root reconstruction using the conventional sandwich technique.The time of extracorporeal circulation,the time of aortic block,the time of stopping circulation,the time of postoperative ventilator use,the diameter of the aortic sinus section and the amount of aortic valve regurgitation were recorded in detail.Complications and deaths were also recorded in detail,and the blood levels of D-dimer(D-D)and C-reactive protein(CRP)were measured before and after the treatment.The patients were followed up for one year and their recovery was assessed.Results In the observation group,the aortic block time[(105.84±17.74)min vs.(123.81±11.28)min],postoperative aortic sinus diameter[(35.03±1.82)mm vs.(37.42±2.01)mm],time to circulatory arrest[(20.31±3.85)min vs.(24.78±3.25)min],postoperative ventilator use time[(66.58±8.89)h vs.(73.43±9.87)h],extracorporeal circulation time[(201.21±18.93)min vs.(218.78±21.09)min],aortic regurgitant flow rate[(0.64±0.21)cm3 vs.(1.12±0.26)cm3],blood D-D[(0.31±0.08)μg/L vs.(0.67±0.12)μg/L],and CRP[(7.03±1.05)μg/L vs.(9.29±1.15)μg/L]were significantly lower than those in the control group,and the difference was statistically significant(P＜0.05).There was no significant difference in the incidence of secondary open-heart haemostasis,haemodialysis,tracheotomy,neurological complications and mortality rates between the two groups(P＞0.05).At six months after the operation,except for those who died,the cardiac function of the rest of the patients after one year of the treatment was class Ⅰ～Ⅱ.Conclusion Total arch replacement with selective brain perfusion and stented elephant trunk technique with priority anastomosis of the aortic arch branches effectively improves surgical techniques,cardiac protection,postoperative recovery,and control of inflammation and coagulation in the treatment of Stanford Type A aortic dissection.
Keywords：Preferential anastomosis of aortic arch branchesTotal arch replacementStenting elephant noseStanford type A aortic coarctationEffectivenessSafety
Publication Date：2024-09-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 847-852 )