Preliminary surgical experience of type A aortic dissection in Kashi district

LIU Si-ming; LYU Hui-bin; Yilihamujiang ABODUNIYAZI; Maimaitiaih MAIMAITI; Abuduwaili REHEMAN; XIN Ying-xu; TIAN Ai-li; ZHU Jia-quan

doi:10.3969/j.issn.1672-5301.2025.04.013

Abstract：Objective We summarize the preliminary surgical experiences of Type A aortic dissection from the Second People's Hospital of Kashi.Methods The 70 patients who underwent surgery of Type A aortic dissection between May 2023 and November 2024 were retrospectively analyzed.All the surgeries were performed by a same surgical team.In the early era,the patients were operated by Shanghai expert,during the late era,some patients were operated by local expert.The perioperative data were collected,and they were compared between the two surgeons in order to analyze teaching effect.Results The average age was 49.7±10 years.There were 57 males(81.6％).The reinforcement of aortic root was performed in 29 patients,the aortic root replacement was performed in 40 patients,while the Wheat procedure was done in 1 patient.Total aortic arch replacement was performed in 55 patients,and partial arch replacement was performed in 8 patients,no arch surgery was needed in the rest 7 patients.Frozen elephant trunk surgery was applied in 53 patients,classic elephant trunk technique was used in 2 patients,while the other 15 patients didn't had surgery on descending aorta.The median anterior cerebral perfusion time during circulatory arrest was 35(29,39)minutes,the median aortic cross clamp time was 175(150,196)minutes,and the median cardiopulmonary bypass time was 284(244,323)minutes.The median mechanical ventilation time after surgery was 91(32,181)hours,and the median ICU stay was 6(4,9)days.The median postoperative hospital stay was 19(13,28)days.Peri-operative complications included acute renal failure requiring hemodialysis in 7 patients,neurological defect in 2 patients,and re-exploration in 6 patients.In total,there were 14 deaths or withdrawing(20％).The cardiopulmonary bypass time was positively correlated with peri-operative death.The local surgeon operated 21 cases(30％).The outcomes between the two surgeons were similar,while the circulatory arrest with cerebral perfusion time was significantly longer in the local expert group when compared to that in the Shanghai expert group(P=0.004).Conclusions Surgery on Type A acute aortic dissection can be performed in Kashi region.The local expert is able to operate independently after training by Shanghai expert.The overall outcome of this surgery is acceptable,while it can still be improved comparing those famous heart institutes all over the world.