Objective To summarize the characteristics and management of pregnancy complicated with aortic dissection, and to explore the reasonable diagnosis and treatment plan. Methods The clinical data of 10 patients of pregnancy complicated with aortic dissection in Wuhan Tongji Hospital from January 2011 to June 2017 were collected. Their age was 25.2 (21-29) years. Results In the 10 patients, the majority (8 patients) were primipara, and most of them were in the late stages of pregnancy (5 patients) and puerperal (4 patients). Among them, 1 patient had gestational hypertension, and the blood pressure of the left and right upper extremities was significantly abnormal (initial blood pressure: left upper limb blood pressure: 90/60 mm Hg, right upper limb blood pressure: 150/90 mm Hg). The major clinical manifestations were severe chest and back pain which happened suddenly, with D-dimmer and C-creative protein increased which may be associated with inflammatory reaction. All patients were diagnosed by thoracoabdominal aortic CTA, including 5 patients of Stanford type A dissection and 5 patients of Stanford type B dissection. In the 10 patients, 1 patient refused surgery and eventually died of aortic rupture with the death of fetus before birth. And the remaining 9 patients underwent surgical treatment, 3 patients of endovascular graft exclusion for thoracic aortic stent graft, 2 patients underwent Bentall operation, 1 patient with Bentall + total aortic arch replacement + vascular thoracic aortic stent graft, 1 patient with Bentall operation combined with endovascular graft exclusion for thoracic aortic stent graft, 1 patient with Bentall + coronary artery bypass grafting, 1 patient of thoracoabdominal aortic vascular replacement. Among them, 1 patient underwent endovascular graft exclusion for thoracic aortic stent graft died of severe postoperative infection, and the remaining 8 patients were discharged from hospital. Nine patients were single birth, among them 5 newborn patients had severe asphyxia, 4 patients had mild asphyxia. Finally, 3 neonates died of severe complications, and the remaining 6 survived. Conclusion The ratio of pregnancy with Stanford type A aortic dissection is far higher than in the general population, the possibility of fetal intrauterine asphyxia is larger, but through active and effective surgical and perioperative treatment, we can effectively save the life of mother and fetus.
ObjectiveTo investigate the effect of in vitro fenestration on reconstruction of left subclavian artery in endovascular treatment of aortic dissection.MethodsA total of 89 patients with aortic dissection involving left subclavian artery were treated by endovascular treatment in the Second Affiliated Hospital of Fujian Medical University from February 2017 to January 2020. There were 44 patients in the test group, including 36 males and 8 females, with an average age of 58.02±13.58 years. There were 45 patients in the control group, including 35 males and 10 females, with an average age of 54.10±12.32 years. The left subclavian artery was reconstructed by in vitro fenestration in the test group and by chimney technique in the control group. The clinical data were compared between the two groups.ResultsThe operation time of the test group was longer than that of the control group (126.16±7.53 min vs. 96.49±6.52 min, P<0.01). The median follow-up time was 31 (13-48) months. The incidence of endoleak in the test group (4.7%) was lower than that in the control group (18.6%, P=0.04) during the follow-up. There was no statistical difference in the incidence of stroke, myocardial infarction, false lumen thrombosis, retrograde aortic dissection or left subclavian artery occlusion between the two groups (P>0.05).Conclusion In vitro fenestration for reconstructing left subclavian artery in thoracic endovascular aortic repair of aortic dissection is safe and feasible, which is worthy of further clinical promotion.
The surgical treatment of acute aortic dissection is difficult, and the mortality is associated with anastomosis site complications. Therefore, it is essential to make sure the end-to-end anastomosis safe and avoid bleeding. The methods of anastomosis include: direct anastomosis, adventitial inversion technique and sandwich technique. The latter two methods are both effective in hemostasis and reducing the postoperative complications. According to the recent literatures, the adventitial inversion technique may facilitate thrombotic closure of the false lumen in acute type A aortic dissection management and increase the long-term survival of the patients. This review introduces 2 modified methods of anastomosis as well, and summarizes clinical outcomes of different end-to-end anastomotic methods for surgical treatment of acute Stanford type A aortic dissection, in order to recommend the most proper method of end-to-end anastomosis.
Objective To investigate the surgical approach and efficacy of reconstruction of the isolated left vertebral artery (ILVA) in single upper hemisternotomy for total aortic arch replacement. Methods From March 2017 to October 2023, patients who underwent total aortic arch replacement under single upper hemisternotomy in General Hospital of Northern Theater Command were selected. According to the presence of ILVA, they were divided into a conventional group and an ILVA group. All the ILVA group underwent intraoperative ILVA reconstruction. The perioperative clinical data between two groups were compared. Results A total of 504 patients were collected, including 471 males and 31 females, with an average age of 50.4±11.4 years. There was no increase in the duration of cardiopulmonary bypass or postoperative hospitalization in the ILVA group (n=31) compared to the conventional group (n=473), and the rates of perioperative complications and in-hospital mortality were not significantly different between the two groups. There were 2 (6.45%) patients of acute cerebral infarction and 2 (6.45%) patients of perioperative death in the ILVA group, with no spinal cord injuries. Conclusion ILVA reconstruction during total aortic arch replacement in single upper hemisternotomy is feasible, safe, and effective, and prioritizing off pump ILVA-left common carotid artery transposition.
ObjectiveTo retrospectively analyze the surgical treatment of Stanford type A aortic dissection after coronary artery stenting, and to explore the surgical techniques and surgical indications. MethodsClinical data of 1 246 consecutive patients who underwent operations on Stanford type A aortic dissection from April 2016 to July 2019 in Beijing Anzhen Hospital were retrospectively analyzed. Patients with Stanford type A aortic dissection after coronary artery stenting were enrolled. ResultsFinally 19 patients were collected, including 16 males and 3 females with an average age of 54±7 years ranging from 35 to 66 years. There were 11 patients in acute phase, 15 patients with AC (DeBakey Ⅰ) type and 4 patients with AS (DeBakey Ⅱ) type. In AC type, there were 10 patients receiving Sun's surgery and 5 patients partial arch replacement. Meanwhile, coronary artery bypass grafting was performed in 7 patients and mitral valve replacement in 1 patient. Stents were removed from the right coronary artery in 4 patients. In this group, 1 patient died of multiple organ failure in hospital after operation combined with malperfusion of viscera. Eighteen patients recovered after treatment and were discharged from hospital. The patients were followed up for 30 (18-56) months. One patient underwent aortic pseudoaneurysm resection, one thoracic endovascular aortic repair, one emergency percutaneous coronary intervention due to left main artery stent occlusion, and one underwent femoral artery bypass due to iliac artery occlusion. ConclusionIatrogenic aortic dissection has a high probability of coronary artery bypass grafting at the same time in patients with Stanford type A aortic dissection after coronary artery stenting. Complicated type A aortic dissection after percutaneous coronary intervention should be treated with surgery aggressively.
During the new coronavirus disease 2019 (COVID-19) pandemic, there has been controversy over whether emergency surgical management should be performed or not in the patients with COVID-19. Stanford type A aortic dissection is a very urgent life-threatening disease, and guidelines recommend surgical treatment for patients with type A aortic dissection in the first instance. However, intraoperative extracorporeal circulation can be fatal to patients recovering from COVID-19. During the pandemic, extracorporeal membrane oxygenation (ECMO) has played an important role in supporting COVID-19 patients with acute respiratory failure. This article reports a successful V-V ECMO treatment for a Stanford type A aortic dissection patient, who suffered respiratory failure caused by COVID-19 after emergency surgery.
Aortic dissection is a life-threatening cardiovascular disease with devastating complications and high mortality. It requires rapid and accurate diagnosis and a focus on prognosis. Many laboratory tests are routinely performed in patients with aortic dissection including D-dimer, brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin. D-dimer shows vital performance in the diagnosis of aortic dissection, and brain natriuretic peptide, cardiac troponin I, C-reactive protein, and procalcitonin exhibits important value in risk stratification and prognostic effect in aortic dissection patients. Our review summarized the clinical utility of these laboratory tests in patients with aortic dissection, aiming to provide advanced and comprehensive evidence for clinicians to better understand these laboratory tests and help their clinical practice.
ObjectiveTo analyze the clinical outcomes of Cabrol procedure for the treatment of Stanford type A aortic dissection. MethodsClinical data of 37 patients with Stanford type A aortic dissection underwent Cabrol procedure at the Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute from January 2009 to April 2014 were retrospectively analyzed. There were 34 males and 3 females aged at 21 to 66 years. The average interval time from onset to getting operation was 15.2±28.5 days. All patients received Cabrol procedure was performed for aortic root. According to different aortic arch conditions, hemiarch replacement or total arch replacement combined endovascular aortic repair with stent were performed. ResultsAll the operations were successfully performed including isolated Cabrol procedure in 4 patients, right hemiarch replacement in 10 patients and total arch replacement combined endovascular aortic repair with stent in 23 patients. One patient (2.7%) underwent reexploration for postoperative bleeding. Postoperative mortality was 10.8% (4/37). Follow-up duration was 1-24 months, 2 patients died during follow-up. ConclusionCabrol procedure has satisfactory clinical outcomes for Stanford type A AD and long-term patency of aortic without coronary oppression.
ObjectiveTo investigate the clinical effect of in situ fenestration combined with chimney technique in the treatment of aortic dissection involving left common carotid artery.MethodsFrom January 2012 to June 2019, 53 patients with aortic dissection involving left common carotid artery were selected. There were 21 patients in the test group, including 14 males and 7 females, with an average age of 57.2±11.2 years; there were 32 patients in the control group, including 20 males and 12 females, with an average age of 56.7±12.1 years. In the test group, the left subclavian branch was reconstructed by in situ fenestration and the left common carotid artery was reconstructed by chimney technique. In the control group, the left common carotid artery was reconstructed by hybrid operation. The clinical data of the patients were compared.ResultsThe operation time of the test group was significantly longer than that of the control group (151.8±35.2 min vs. 101.3±29.6 min, P=0.00). The patients in the two groups were followed up for 6-20 months. There was no significant difference in the incidence of pulmonary infection, stroke, steal blood syndrome, false lumen thrombosis or internal leakage between the two groups (P>0.05). The diameters of the distal and proximal ends of the true cavity in the test group increased significantly compared with those in the control group (P<0.05).ConclusionIn situ fenestration combined with chimney technique is an effective method for the treatment of aortic dissection involving left common carotid artery, which is worthy of further clinical promotion.
ObjectiveTo assess the causes and risk factors of multiple-intervention in endovascular aortic repair (EVAR) for type B aortic dissection (TBAD). MethodsWe retrospectively analyzed the clinical data of 347 TBAD patients initially treated with EVAR in our hospital between January 1999 and December 2013. The patients were stratified into a multiple-intervention group (34 patients) and a single-intervention group (313 patients). We analyzed the differences of clinical data of the two groups. ResultsThere were 9 patients with endoleak, 10 patients with new dissection, 8 patients with incomplete thrombosis of the false lumen, 4 patients with new aneurysm, 2 patients with retrograde dissection, and 1 patient with iliac artery occlusion in the multiple-intervention group. Higher proportions of chronic dissection and smoking occurred in the multiple-intervention group (79.4% versus 50.8%, 61.8% versus 40.3%, P=0.002, 0.018, respectively). Both of the degree and proportion of hyperglycemia were higher in the multiple-intervention group (6.9±2.3 mmol/L versus 5.7±1.8 mmol/L, P=0.027; 44.1% versus 22.7%, P=0.011). There were statistical differences in oversizing rate of grafts (14.6%±3.2% versus 11.3%±2.5%, P<0.001), operation time (172 min versus 82 min, P<0.001), and blood loss (280 ml versus 100 ml, P=0.006) between the two groups. ConclusionEndoleak, new dissection, and incomplete thrombosis of the false lumen are the main causes of multiple-intervention. While in chronic phase, smoking, hyperglycemia, too big oversizing, and complicated lesion or operation are the potential risk factors.