[Late reoperations after repaired Stanford type A aortic dissection].

Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years. In these patients, first time operations were ascending aorta replacement procedure in 3 patients, ascending aorta combined with partial aortic arch replacement in 4 patients, aortic root replacement (Bentall) associated with Marfan syndrome in 3 patients, aortic valve combined with ascending aorta replacement (Wheat) in 1 patient, ascending aorta combined with Sun's procedure in 1 patient, Wheat combined with Sun's procedure in 1 patient, Bentall combined with Sun's procedure in 1 patient. The interval between two operations averaged 0.3 to 10.0 years with a mean of (4.8±3.1) years. The reasons for reoperations included part anastomotic split, aortic valve insufficiency, false aneurysm formation, enlargement of remant aortal and false cavity. The selection of reoperation included anastomotic repair, aortic valve replacement, total arch replacement and Sun's procedure. Results: Of the 14 patients, the cardiopulmonary bypass times were 107 to 409 minutes with a mean of (204±51) minutes, cross clamp times were 60 to 212 minutes with a mean of (108±35) minutes, selective cerebral perfusion times were 16 to 38 minutes with a mean of (21±11) minutes. All patients survived from the operation, one patient died from severe pulmonary infection 50 days after operation. Three patients had postoperative complications, including acute renal failure of 2 patients and pulmonary infection of 1 patient, and these patients were recovered after treatment. Thirteen patients were finally recovered from hospital. The patients were followed up for 16 to 45 months, and no aortic rupture, paraplegia and death were observed in the follow-up. Conclusions: Patients for residual aortic dissection after initial operations on Stanford type A aortic dissection should be attached great importance and always need emergency surgery, but the technique is demanding and risk is great for surgeons and patients, which need enough specification and accurate on aortic operation. More importantly, the Sun's procedure also should be performed on the treatment of residual aortic dissection or distal arch expansion, and obtains the short- and long-term results in the future.目的： 探讨Stanford A型主动脉夹层再手术治疗的效果。 方法： 回顾性分析2008年8月至2016年10月南京医科大学附属南京医院胸心血管外科施行二次手术的14例Stanford A型主动脉夹层术后发生手术后并发症的患者。男性10例，女性4例；年龄41～76岁，平均(57±12)岁。首次手术为升主动脉替换术3例，升主动脉＋右半弓替换术4例，马方综合征合并夹层行主动脉根部替换术(Bentall手术)3例，主动脉瓣＋升主动脉替换术(Wheat手术)1例，升主动脉替换＋全主动脉弓替换及降主动脉支架象鼻人工血管置入术(孙氏手术)1例，Wheat手术＋孙氏手术1例，Bentall手术＋孙氏手术1例。再手术距首次手术0.3～10.0年，平均(4.8±3.1)年。再手术原因包括吻合口部分裂开、主动脉瓣关闭不全、假性动脉瘤形成、残余主动脉或假腔增粗。再手术术式选择吻合口修补、主动脉瓣置换或孙氏手术。 结果： 14例患者顺利完成手术。心肺转流时间107～409 min，平均(204±51)min；主动脉阻断时间60～212 min，平均(108±35)min；10例行深低温停循环、低流量选择性脑灌注，灌注时间16～38 min，平均(21±11)min。无手术早期死亡，1例患者术后50 d死于肺炎。术后3例发生并发症，其中急性肾功能衰竭2例，肺部感染1例，均于治疗后痊愈。13例患者康复出院。生存患者随访16～45个月，平均(26±12)个月，随访期间无夹层破裂、截瘫和死亡病例。 结论： Stanford A型主动脉夹层术后根部残余夹层或远端弓部扩张的患者应及时手术治疗，手术难度及风险均较初次主动脉夹层手术增加，应注意主动脉操作的规范和准确，尽量施行孙氏手术，可获得满意的短期及长期临床结果。.