Reoperation after repair of type A and B dissecting aneurysm.
Reoperation after repair of type A and B dissecting aneurysm.
复制标题
A型和B型夹层动脉瘤修复后再次手术。
DOI：
10.1016/0003-4975(94)00958-a
复制
发表时间：
1998
期刊：
影响因子：
--
通讯作者：
H. Wakiyama
中科院分区：
文献类型：
--
作者：
C. Yamashita;M. Okada;K. Ataka;M. Yoshida;T. Azami;M. Ozaki;K. Nakagiri;T. Yamashita;H. Wakiyama
背景
在主动脉夹层或夹层动脉瘤修复术后晚期，可能需要再次手术。观察再手术时间、内膜撕裂的大小、位置及再手术效果。
方法
在1982年1月至1997年4月期间，138名患者接受了斯坦福大学A型（90名患者）或B型（48名患者）主动脉夹层手术。术后随访6个月至15年，通过计算机断层扫描和磁共振成像对整个主动脉进行评价。14例（10.1%）患者在初次修复部位或远端主动脉发生动脉瘤变化时进行了再次手术。采用选择性脑灌注或深低温逆行脑灌注修复升动脉瘤、弓状动脉瘤和远侧弓状动脉瘤。再次手术包括主动脉根部重建（n=3）、假性动脉瘤切除（n=1）和升主动脉置换（n=1）、主动脉弓置换（n=5）、降主动脉置换（n=2）、胸腹主动脉置换（n=1）或腹主动脉置换（n=1）。4例患者进行了二次再手术（主动脉弓[n=2]、胸腹主动脉和腹主动脉置换）。因此，2例患者接受了主动脉次全置换术。动脉瘤是由吻合口漏、主动脉阻断后新的内膜撕裂、远端弓或腹主动脉中的第二内膜撕裂和马凡综合征引起的。
结果
2例（2/18，11.1%）死于出血或低心排综合征。2例患者分别于术后3个月死于移植物感染或人工瓣膜感染。
结论
1)A、B型夹层再次手术效果良好。2)对整个主动脉中的未闭假腔进行密切的术后随访是必要的。3)在初次手术中，低风险患者主动脉弓内膜撕裂的全切除降低了再次手术的风险。
BACKGROUND
In the late postoperative period after repair of an aortic dissection or dissecting aneurysm, reoperations may be required. The interval to reoperation, size and location of intimal tear, and results of reoperation were evaluated.
METHODS
Between January 1982 and April 1997, 138 patients underwent surgery for Stanford type A (90 patients) or type B (48 patients) dissections of the aorta. The entire aorta was evaluated in postoperative follow-up by computed tomography and magnetic resonance imaging for 6 months to 15 years. Reoperations were performed in 14 (10.1%) patients with changes in the aneurysms at the site of the initial repair or in the distal aorta. Selective cerebral perfusion or retrograde cerebral perfusion with deep hypothermia was used in the repair of the ascending, arch, and distal arch aneurysms. Reoperations included aortic root reconstruction (n=3), resection of a pseudoaneurysm (n=1), and replacement of the ascending aorta (n=1), arch (n=5), descending aorta (n=2), thoracoabdominal aorta (n=1), or abdominal aorta (n=1). Secondary reoperations were performed in four patients (replacement of the arch [n=2], thoracoabdominal aorta and abdominal aorta). Consequently two patients had subtotal aortic replacements. The aneurysms were caused by an anastomotic leak, a new intimal tear following aortic cross-clamping, a second intimal tear in the distal arch or abdominal aorta, and Marfan syndrome.
RESULTS
Two patients (2/18 11.1%) died of bleeding or low output syndrome. Two patients died of graft infection or prosthetic valve infection 3 months after surgery respectively.
CONCLUSIONS
1) The surgical results of reoperation for type A and B dissections were good. 2) Close postoperative follow-up of the patent false lumen in the entire aorta was necessary. 3) At the initial operation, total resection of the intimal tear in the aortic arch in low-risk patients reduced the risk of reoperation.