Perioperative management of Debakey I aortic dissection by new type of three branches aortic arch covered stent graft implantation

Abstract

Objective To investgate the proper perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation. Methods A total of 56cases with Debakey Ⅰ aortic dissection were enrolled into the study and operated by new type of three branches aortic arch covered stent graft implantation from July 2009 to August 2010. Results The cardiopulmonary bypass time during the operation was 90. 0 -248.0 min( median time 180. 6 ains) ,aortic cross clamp time was 69. 0 - 180. 0 min(median time 108. 2 mins) ,circulation arrest time was 17.0 -37.0 min ( median time 22. 6mins) ,the time using reathing apparatus was 16.0 -260.0 hours (median time 42. 8 hours),ICU residence time was 3.0 -23. 0 days( median time 6. 6 days). Fifty-four patients got well and were discharged. One patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection. Key words: Debakey Ⅰ aortic dissection; Perioperative management; Complication