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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
[Surgical treatment of DeBakey type I and II aortic dissection]
1Department of Cardiac Surgery, Cardiovascular Institute, Fuwai Hospital, CAMS, PUMC, Beijing 100037, China.
Insights
Surgical repair of DeBakey I and II aortic dissection is challenging. Selective cerebral perfusion during surgery offers protection and extends repair time, with a low 3.05% operative mortality.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
Context:
- Aortic dissection, particularly DeBakey types I and II, presents significant surgical challenges.
- Despite advancements, these complex lesions demand sophisticated treatment strategies.
Purpose:
- To evaluate surgical outcomes for DeBakey I and II aortic dissection.
- To assess the efficacy of hypothermic circulatory arrest with selective cerebral perfusion.
Summary:
- 131 patients with DeBakey I, II aortic dissection underwent surgical repair between 1994 and 2000.
- Various techniques were employed, including graft replacement, Bentall procedure, and elephant trunk techniques.
- Selective cerebral perfusion was utilized in 57 patients, demonstrating its protective role.
Impact:
- The study reports a low operative mortality of 3.05% (4 deaths within 30 days).
- Neurological dysfunction occurred in 3 patients but resolved within a week.
- Selective cerebral perfusion is highlighted as a crucial technique for protecting the brain during extended aortic dissection repair.
Objective:
Aortic dissection is associated with significant mortality and morbidity. Effective methods to treat aortic disection are now available although these lesions still challenge the cardiovascular surgeon.
Methods:
From January 1994 to January 2000. 131 patients with DeBakey I, II type aortic dissection underwent surgical treatment. Operations were performed under cardiopulmonary bypass in 59 patients. Hypothermic circulatory arrest was used in 15 patients. Hypothermic circulatory arrest and selective cerebral perfusion was used in 57 patients. A graft replacement of ascending aorta and partial aortic arch was performed in 25 patients, ascending aorta and total aortic arch in 10. 83 patients underwent the Bentall procedure. The Bentall procedure and total aortic arch replacement were performed in 3 patients, the Wheats operation in 4. 4 patients underwent the elephant trunk techniques and 2 patients with the elephant trunk techniques and the Bentall procedures.
Results:
There were 4 deaths within 30 days after surgery with an operative mortality of 3.05%, and 3 neurological dysfunction undergone hypothermic circulatory arrest. They were recovered within 1 week.
Conclusion:
The operative technique is difficult. Selective cerebral perfusion can provide available protection during surgery of aortic dissection. It prolongs the time allowed to performed the aortic repair.
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