摘要目的 总结急性DeBakey Ⅰ型主动脉夹层的弓部外科治疗策略及中期随访结果 方法 涉及主动脉弓部的急性DeBakey Ⅰ型主动脉夹层手术75例,男65例,女10例,平均年龄45.0±8.9岁(23～ 72岁).其中升主动脉加右半弓替换43例,全主动脉弓部替换32例.全弓替换手术中,采用三分支人工血管吻合技术或其改良技术18例,弓部岛状移植或改良移植技术10例,改良四分支人工血管全弓替换手术4例,同期术中降主动脉内支架置入手术18例.同期行主动脉根部替换(Bentall手术)20例.内膜破口位于弓部大弯侧或降主动脉起始部位时行全弓替换.常规经右腋动脉插管做体外循环动脉灌注,全弓替换时行脑顺行灌注保护.半弓替换在脑部停循环下完成.结果 平均体外循环(212.9±71.5) min,主动脉阻断(135.2±51.5) min,脑部停循环(28.3±20.5) min.呼吸机辅助通气时间11～460 h.死亡5例(6.7％).术后需床旁血滤的肾功能衰竭6例,脑部并发症4例,二次开胸止血3例,一过性截瘫1例.随访平均3.5年,生存率94.2％.4例再次行降主动脉支架置入.结论 主动脉夹层手术死亡和并发症发生率高.个体化选择半弓或全弓替换手术方案,可减少手术死亡,中期随访生存率良好.

abstractsObjective To summary the surgical strategy of acute DeBakey type Ⅰ dissection involving aortic arch and the short-term and mid-term results.Methods Between January 2006 and August 2013,75 patients [(aged(45.0 ± 8.9) years;65 men,10 women] with acute DeBakey type Ⅰ aortic dissection were operated on.When intimal disruption was located at bigger curvature or proximal descending aorta,total arch replacement was performed.Forty three patients received semi-arch replacement and 32 patients received total arch replacement.Three kinds of techniques,respectively using trifurcated graft,Carrel patch and four branched graft,were utilized in total arch replacement.Concomitant aortic root replacement with composite valve graft was performed in 20 patients.Frozen elephant trunk was implanted in 18 patients during arch repair.Right axillary artery was routinely cannulated for arterial inflow and selective antegrade cerebral perfusion during hypothermic circulatory arrest.Results Seventy patients were discharged and 5 patients died resulting in in-hospital mortality rate 6.7％.Neurologic complications occurred in 4 patients,re-exploration for bleeding in 3,acute renal failure needing hemodialysis in 6,and paraplegia in 1.Mean cardiopulmonary bypass time was (212.9 ± 71.5) min,aortic cross clamping time (135.2 ± 51.5) min,and hypothermic circulatory arrest time(28.3 ± 20.5)min.During a mean follow-up of 3.5 years,survival rate was 94.2％ and 4 patients received endovascular stent implantation in descending aorta because of aneurismal dilation.Conclusion Surgery for acute aortic dissection is challenging with high operative mortality and morbidity.Individualized selection of semi-arch or total arch replacement is necessary to improve postoperative outcomes and the mid-term survival is encouraging.