Extensive repair of acute type A aortic dissection through a partial upper sternotomy and using complete stent-graft replacement of the arch
| Autor: | Liang-Wan Chen, De-Bin Jiang, Xian-Biao Xie, Guan-Hua Fang, Zhi-Huang Qiu, Xiao-Fu Dai |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult medicine.medical_specialty medicine.medical_treatment Aorta Thoracic 030204 cardiovascular system & hematology law.invention 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine law Cardiopulmonary bypass medicine Humans Retrospective Studies Surgical repair Aortic dissection Aortic Aneurysm Thoracic business.industry Stent medicine.disease Intensive care unit Sternotomy Surgery Aortic cross-clamp Aortic Dissection medicine.anatomical_structure Treatment Outcome 030228 respiratory system Propensity score matching Stents Intercostal space Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 164(4) |
| ISSN: | 1097-685X |
| Popis: | Partial upper sternotomy (mini-ER) can be used in some adult cardiac surgeries but is seldom performed in the treatment of acute type A aortic dissection (AAAD). This study aimed to assess the feasibility and short-term outcomes of complete stent-graft replacement of the arch with triple-branched stent graft for AAAD through a mini-ER.From 2015 to 2018, 254 patients with AAAD underwent complete stent-graft replacement of the arch with a triple-branched stent graft. Replacement was performed with conventional full sternotomy (con-ER) in 142 patients and with mini-ER in the other 112 patients. Using propensity score matching, the clinical data were compared between 100 patients in the mini-ER group and 100 patients in the con-ER group.After propensity score matching, there were no significant between-group differences in aortic cross-clamp time, cardiopulmonary bypass time, or total operative time. The amount of mediastinal drainage and number of red blood cell units were significantly lower in the mini-ER group compared with the con-ER group (P .001). The intubation time was significantly shorter in the mini-ER group (P .001). The treatment costs were also lower in the mini-ER group (P .001). There were no significant between-group differences in 30-day mortality (9% vs 8%; P .99) or postoperative complications.This study shows that extensive repair of AAAD through a mini-ER is feasible. It was superior to con-ER in terms of blood loss, postoperative ventilation time, and treatment costs. |
| Databáze: | OpenAIRE |
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