Curative effect analysis of Sun’s procedure for acute or chronic Stanford A aortic dissection: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yijin , XIONG Weiping , ZENG Rong , FAN Xiaoping , YU Changjiang , LI Xin ,  FAN Ruixin

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P.R.China;

Corresponding author：

FAN Ruixin, Email: fanruixin@163.com

Keywords：

Aortic dissection; Sun’s procedure; curative effect

DOI：

10.7507/1007-4848.201705059

Video：

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Objective To analyze the surgical effect of total aortic arch replacement and stented elephant trunk (Sun’s procedure) for acute or chronic Stanford type A aortic dissection, and to investigate the optimal surgical timing for Stanford type A aortic dissection involving aortic arch. Methods We retrospectively reviewed the clinical data of 327 patients with acute or chronic Stanford type A aortic dissection treated by Sun's procedure from June 2010 to June 2014 in Guangdong Cardiovascular Institute. Patients were divided into two groups according to whether the time from onset to operation was longer than 2 weeks: an acute group with 229 patients (≤2 weeks, the average time of onset to operation 5.70±3.50 d) and a chronic group with 98 patients (>2 weeks, the average time of onset to operation 21.60±15.70 d). There were 186 males and 43 females with a mean age of 47.47±11.19 years in the acute group, and 76 males and 22 females with a mean age of 45.62±12.92 years in the chronic group. The patients discharged from hospital were followed up for one year. Results There was no significant difference between the two groups in preoperative data. The rate of coronary artery bypass grafting, cardiopulmonary bypass time, aortic cross-clamping time, intraoperative and postoperative 24 h red blood cell intake were higher or more in the acute group than those in the chronic group (P<0.05). The in-hospital morality, ICU stay, mechanical ventilation time, the incidence of neurological dysfunction, low cardiac output syndrome, acute renal failure with continuous renal replacement therapy, hepatic insufficiency, poor wound healing were higher or more in the acute group than those in the chronic group (P<0.05). During one year follow-up, the survival rate of the acute and chronic groups was 97.0% and 97.6% respectively (P>0.05). No new complications were found in the two groups. The irreversible neurological dysfunction, paraplegia and renal failure showed no significant difference between the two groups. Conclusion The short-term mortality and complications of acute Stanford A aortic dissection involving aortic arch treated by Sun’s procedure are significantly higher or more than those of chronic Stanford type A aortic dissection. The risk of surgical treatment in acute phase is high.

Citation： WU Yijin, XIONG Weiping, ZENG Rong, FAN Xiaoping, YU Changjiang, LI Xin, FAN Ruixin. Curative effect analysis of Sun’s procedure for acute or chronic Stanford A aortic dissection: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(5): 401-405. doi: 10.7507/1007-4848.201705059 Copy

1.	Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J, 2001, 22(18): 1642-1681.
2.	郑斯宏, 孙衍庆, 孟旭, 等. Stanford A 型主动脉夹层的外科治疗. 中华外科杂志, 2005, 43(18): 1177-1180.
3.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
4.	Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1): 31-35.
5.	Imasaka K, Tayama E, Tomita Y, et al. Preoperative renal function and surgical outcomes in patients with acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2015; 20(4): 470-476.
6.	Kouchoukos NT, Masetti P, Rokkas CK, et al. Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg, 2002, 74(5): S1885-S1887.
7.	Harward TR, Welborn MB 3rd, Martin TD, et al. Visceral ischemia and organ dysfunction after thoracoabdominal aortic aneurysm repair. A clinical and cost analysis. Ann Surg, 1996, 223(6): 729-734.
8.	De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci, 2012, 28(6): 299-305.
9.	Shimada S, Nakamura H, Kurooka A, et al. Fever associated with acute aortic dissection. Circ J, 2007, 71(5): 766-771.
10.	Wen D, Zhou XL, Li JJ, et al. Plasma connection of interleukin-6, C-reactive protein, tumor necrosis factor-alpha and matrix metalloproteinase-9 in aortic dissection. Clin Chim Acta, 2012, 413(1-2): 198-202.
11.	Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
12.	Bhargava M, Wendt CH. Biomarkers in acute lung injury. Transl Res, 2012, 159(4): 205-217.
13.	del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
14.	Wu D, Shen YH, Russell L, et al. Molecular mechanisms of thoracic aortic dissection. J Surg Res, 2013, 184(2): 907-924.
15.	王亮, 常谦, 于存涛, 等. Stanford A 型主动脉夹层术后院内死亡危险因素分析. 中华外科杂志, 2012, 50(5): 422-425.
16.	Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250.
17.	Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
18.	Ius F, Fleissner F, Pichlmaier M, et al. Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience. Eur J Cardiothorac Surg, 2013, 44(5): 949-957.
19.	Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg, 2011, 40(4): 881-887.
20.	Sun LZ, Qi RD, Chang Q, et al. Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J Thorac Cardiovasc Surg, 2009, 138(4): 892-896.
21.	孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18): 1171-1176.
22.	Turak O, Canpolat U, Ozcan F, et al. D-dimer level predicts in-hospital mortality in patients with infective endocarditis: a prospective single-centre study. Thromb Res, 2014, 134(3): 587-592.
23.	Lin CH, Chen SC, Chen WJ, et al. Dimerized plasmin fragment D: a reliable biomarker for diagnosing aortic dissection? Am J Emerg Med, 2010, 28(1): 121. e1-e3.
24.	Albini P, Barshes NR, Russel L, et al. D-dimer levels remain elevated in acute aortic dissection after 24 h. J Surg Res, 2014, 191(1): 58-63.

1. Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J, 2001, 22(18): 1642-1681.
2. 郑斯宏, 孙衍庆, 孟旭, 等. Stanford A 型主动脉夹层的外科治疗. 中华外科杂志, 2005, 43(18): 1177-1180.
3. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new "standard" therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
4. Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1): 31-35.
5. Imasaka K, Tayama E, Tomita Y, et al. Preoperative renal function and surgical outcomes in patients with acute type A aortic dissection. Interact Cardiovasc Thorac Surg, 2015; 20(4): 470-476.
6. Kouchoukos NT, Masetti P, Rokkas CK, et al. Hypothermic cardiopulmonary bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg, 2002, 74(5): S1885-S1887.
7. Harward TR, Welborn MB 3rd, Martin TD, et al. Visceral ischemia and organ dysfunction after thoracoabdominal aortic aneurysm repair. A clinical and cost analysis. Ann Surg, 1996, 223(6): 729-734.
8. De León Ayala IA, Chen YF. Acute aortic dissection: an update. Kaohsiung J Med Sci, 2012, 28(6): 299-305.
9. Shimada S, Nakamura H, Kurooka A, et al. Fever associated with acute aortic dissection. Circ J, 2007, 71(5): 766-771.
10. Wen D, Zhou XL, Li JJ, et al. Plasma connection of interleukin-6, C-reactive protein, tumor necrosis factor-alpha and matrix metalloproteinase-9 in aortic dissection. Clin Chim Acta, 2012, 413(1-2): 198-202.
11. Wen D, Du X, Dong JZ, et al. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart, 2013, 99(16): 1192-1197.
12. Bhargava M, Wendt CH. Biomarkers in acute lung injury. Transl Res, 2012, 159(4): 205-217.
13. del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
14. Wu D, Shen YH, Russell L, et al. Molecular mechanisms of thoracic aortic dissection. J Surg Res, 2013, 184(2): 907-924.
15. 王亮, 常谦, 于存涛, 等. Stanford A 型主动脉夹层术后院内死亡危险因素分析. 中华外科杂志, 2012, 50(5): 422-425.
16. Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4): 1246-1250.
17. Bekkers JA, Raap GB, Takkenberg JJ, et al. Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg, 2013, 43(2): 389-396.
18. Ius F, Fleissner F, Pichlmaier M, et al. Total aortic arch replacement with the frozen elephant trunk technique: 10-year follow-up single-centre experience. Eur J Cardiothorac Surg, 2013, 44(5): 949-957.
19. Kim JB, Chung CH, Moon DH, et al. Total arch repair versus hemiarch repair in the management of acute DeBakey type I aortic dissection. Eur J Cardiothorac Surg, 2011, 40(4): 881-887.
20. Sun LZ, Qi RD, Chang Q, et al. Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? J Thorac Cardiovasc Surg, 2009, 138(4): 892-896.
21. 孙立忠, 刘宁宁, 常谦, 等. 主动脉夹层的细化分型及其应用. 中华外科杂志, 2005, 43(18): 1171-1176.
22. Turak O, Canpolat U, Ozcan F, et al. D-dimer level predicts in-hospital mortality in patients with infective endocarditis: a prospective single-centre study. Thromb Res, 2014, 134(3): 587-592.
23. Lin CH, Chen SC, Chen WJ, et al. Dimerized plasmin fragment D: a reliable biomarker for diagnosing aortic dissection? Am J Emerg Med, 2010, 28(1): 121. e1-e3.
24. Albini P, Barshes NR, Russel L, et al. D-dimer levels remain elevated in acute aortic dissection after 24 h. J Surg Res, 2014, 191(1): 58-63.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Curative effect analysis of Sun’s procedure for acute or chronic Stanford A aortic dissection: A case control study

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