Sun’s procedure with preservation of autologous brachiocephalic vessels for chronic type A aortic dissection

Abstract

Objective To summarize the clinical outcomes and surgical indications for chronic type A aortic dissection(CTAD) by using Sun’s procedure with preservation of autologous brachiocephalic vessels. Methods From September 2010 to December 2013, 23 patients with CTAD underwent Sun’s procedure with preservation of autologous brachiocephalic vessels under moderate hypothermic circulatory arrest combined with selective cerebral perfusion in our center. The data was collected and analysed retrospectively. There were 20 males and 3 females patients with a mean age of(49.91±10.05) years. Preoperative comorbidities included Marfan syndrome in 1 patient, isolated left vertebral artery in 1, hypertension in 19, coronary artery disease in 2, heart dysfunction in 1, renal insufficiency in 1, mitral regurgitation in 1, and pulmonary infection in 1. Previous operation history included thoracic endovascular aortic repair in 3, percutaneous coronary intervention in 1, aortic valve replacement in 1, Bentall procedure in 1, and coronary artery bypass grafting in 1. Results The average operation time, cardiopulmonary bypass time, aortic cross clamping time and selective cerebral perfusion time was(6.43±1.03) h, (167.07±49.62) min, (80.74±29.00) min, and(27.35±6.03) min, respectively. Concomitant procedures included Bentall procedure in 6 patients, ascending aorta replacement in 17, ascending aorta-femoral artery bypass in 1, mitral valvuloplasty in 1, and CABG in 1. There were 2(8.70%) in hospital deaths. Three patients suffered temporary renal dysfunction, and 1 with renal failure recieved continuous renal replacement therapy. Postoperative hypoxemia were found in 2 patients, and 1 of them received reintubation. These patients recovered before discharge. The mean follow-up time was(52.52±9.89) months with a follow-up rate of 95.23%(20/21). One patient suffered cerebral embolism but recovered soon after treatment. The others were free from any complications. Conclusion Sun’s procedure with preservation of autologous brachiocephalic vessels simplified the aortic arch surgery and obtained satisfactory outcomes for suitable patients with CTAD, but surgical indications should be strictly considered. Key words: Chronic type A aortic dissection(CTAD) Sun’s procedure Total arch replacement En block technique