Aortic Dissection: Single Center Experience with Surgical Treatment

本研究的目的是報告我們主動脈剝離手術的結果與術後的追蹤，對手術後發生腦病變的可能原因亦有所討論。從2000年10月至2004年4月，共23個病人（男18人，女5人，平均年齡54.8±15.8歲）因主動脈剝離在本院接受手術。根據Standford的分類方式，有19個病患屬於A型主動脈剝離，有4個病患屬於B型主動脈剝離。馬煩氏症候群(Marfan syndrome)病患有5位。除了2位馬煩氏症候群病患之外，所有病患皆以深度低溫循環中止合併逆行性灌注的方式進行手術。手術的方式包含：升主動脈置換有9位(39.1%)，升主動脈置換與主動脈瓣膜置換有1位(4.3%)，升主動脈胃換與主動脈瓣膜懸吊有6位(26.1%)，升主動脈置換、主動脈瓣膜懸吊與冠狀動脈繞道手術有2位(8.7%)，Bentall手術有3位(13.0%)，Bentall手術與冠狀動脈繞道手術有2位(8.7%)。結果是所有病患在手術後全部存活並可順利出院。有3位病患有腦中風的併發症。所有手術病患皆有接受術後追蹤，平均追蹤時間為20.7±14.2個月（2-40個月）。所有手術病患於術後追蹤時皆意識清楚。有5位病患晚期死亡，術後一年與二年的存活率均為78.9%，術後三年的存活率為70.1%。主動脈剝離對心臟血管外科醫師而言是一項挑戰。然而，以深度低溫循環中止合併逆行性灌注的方式進行手術可得不錯的手術結果與可接受的手術併發症。

關鍵字

無資料

並列摘要

Objectives: This study reports our surgical results for aortic dissection and the post-operative follow up. Possible reasons for post-operative cerebral insults are discussed. Methods: From October 2000 to April 2004, 23 patients (18 men; 5 women; mean age 54.8±15.8 years) underwent operation for aortic dissection in our hospital. According to the Standford classification, there were 19 cases in Type A and 4 cases in Type B. Five patients had a Marfan syndrome. All the cases except two with the Marfan syndrome had surgery under profound hypothermic circulatory arrest with retrograde perfusion. Surgical strategies included aortic grafting only (9/23, 39.1%), aortic valve replacement with supracoronary ascending aortic grafting (1/23, 4.3%), aortic valve resuspension with supracoronary ascending aortic grafting (6/23, 26.1%), aortic valve resuspension with supracoronary ascending aortic grafting and coronary artery bypass grafting (2/23, 8.7%), Bentall operation (3/23, 13.0%) and Bentall operation with coronary artery bypass grafting (2/23, 8.7%). Results: There was no operative or in-hospital mortality. Median ventilator supporting time was 4 days (range: 1 to 94). Re-exploration for hemostasis was needed in 2 patients. Cerebral ischemic infarction was found in 3 patients. All the patients received post-operative follow up. Mean follow-up time was 20.7±14.2 months (range: 2 to 40). All the patients had clear consciousness during the follow up. There were 5 late deaths. Both the one-year and two-year survival rates were 78.9%, and the three-year survival rate was 70.1%. Conclusion: Aortic dissection is a challenge for cardiovascular surgeons. However, good results and acceptable morbidities can be achieved under profound hypothermic circulatory arrest with retrograde perfusion.

並列關鍵字

aortic dissection ； profound hypothermic circulatory arrest ； retrograde cerebral perfusion ； total body retrograde perfusion

國際替代計量

Aortic Dissection: Single Center Experience with Surgical Treatment

全文下載

主題瀏覽