三分支主动脉弓覆膜支架植入治疗Stanford A型主动脉夹层的研究

目的：总结三分支主动脉弓覆膜支架治疗Stanford A型主动脉夹层的临床经验。方法：2009年3月至2011年4月,13例Stanford A型主动脉夹层患者在体外循环下先进近心端操作,降温至20℃,停循环,选择性脑灌注,经无名动脉近端升主动脉横断切口,采用三分支主动脉弓覆膜支架重建主动脉弓,主干支架血管近端与替换近端升主动脉的人造血管端端吻合,主动脉根部用自体心包片与右房建立分流,出院复查心脏彩超和主动脉电子束CT。结果：所有患者术中均顺利植入三分支主动脉弓覆膜支架,体外循环时间（221.33±37.98）min,心肌阻断时间（124.77±50.00）min,停循环时间（28.38±8.12）min,选择性脑灌注时间（19.30±9.57）min。术后早期死亡1例,死因分别为不完全肠梗阻以及急性缺血性脑病,最终引起多器官功能衰竭。出院时复查主动脉电子束CT提示：主干支架血管及分支血管通畅,无扭曲,主动脉弓和胸降主动脉假腔部分血栓形成。结论：采用三分支主动脉弓覆膜支架治疗Stanford A型主动脉夹层可简化主动脉弓部手术,降低手术风险,适合于人多数Stanford A型主动脉夹层患者的治疗,长期效果尚需进一步观察。

Treatment of Type A Stanford Aortic Dissection by Three Branches Aortic Arch Covered Stent Graft Implantation

Objective：To evaluate surgical effects of three branches aortic arch covered stent graft on treatment of Stanford type A aortic dissection.Methods：Between March 2009 and April 2011,13 well selected patients with Stanford type A aortic dissection Underwent open three branches aortic arch covered stent graft implantation for arch reconstruction.When core cooling to 20℃ nasopharyngeal temperature,deep hypothermic circulatory arrested,Selected cerebra perfusion,and the ascending aorta was transected.Through the transverse incision,three branches aortic arch covered stent graft was inserted into the true lumen of the arch and descending aorta.The transected stump of the ascending aorta was reconstructed by end-to-end anastomosis of inner proximal stent graft-free Darcon tube of the main graft and distal artificial blood vessel,aortoatrial shunts were performed for inaccessible bleeding in aortic root.Results：Three branches aortic arch covered stent graft was technically successful in all patients.The mean cardiopulmonary bypass time,aortic cross clamp time,circulatory arrested time,average selective cerebral perfusion time were（221.33±37.98）min,（124.77±50.00）min,（28.38± 8.12）min,（19.30±9.57）min,respectively.One patient died of multiple organ dysfunctions result from intestinal obstruction and acute ischemic attack.Their computed tomography scans postoperatively showed that all stent grafts were fully opened and not kinked,no space or blood flow surrounding the Three branches aortic arch covered stent.The false lumen of the descending aorta distal to the stent graft closed with thrombus partly.Conclusion：Three branches aortic arch covered stent graft simplified the aortic arch operation,and lower operative risk in treatment of Stanford type A aortic dissection,its long-term results need advanced observation.