P322. Surgical Strategies and Outcomes of Aortic Root in Complicated Acute Type A Aortic Dissection
Second Hospital of Jilin University
Jilin, Jilin
China - Contact Me
Dr Liu has been excellent in all kinds of aortic diseases such as acute aortic dissection, coronary artery bypass graft (CABG) in treating coronary artery disease and acute myocardial infarction, modified Maze procedure in ablation of atrial fibrillation, valve replacement and valvuloplasty, minimally invasive cardiac surgery, cardiac trauma, correction of various complex congenital heart diseases and surgical treatment of other common congenital and acquired cardiac diseases. He took the lead in carrying out surgical treatment of aortic diseases in the Northeast of China in 2005, especially in the surgical treatment of acute aortic dissection. Since 2009, professor Kexiang Liu has been devoting lots of efforts to the modifications of treatment of Stanford A aortic dissection, thus creating a novel technique. This novel modified surgical method not only reduces the blood loss, shortens operative time, but also improves the success rate of the surgery, simplifies the complexities of the traditional surgery patterns. The innovations of “Modified Stented-Graft” and “Stented-graft with Artificial Vascular Prothesis ” both obtained national patent. New Progress has been made remarkably since 2016 in the field that more than 50.8% of the aortic dissection surgeries have been performed without blood transfusions.Being the first to carry out independent coronary artery bypass graft (CABG) surgeries in Jilin Province, more than 95% are off-pump and the successful rate reaches more than 99% and the rate of no blood transfusion has reached 93%. Professor Kexiang Liu took the lead in performing hybrid operations containing multiple valve replacement, CABG and surgical ablation of atrial fibrillation. He has been promoting the use of autologous blood recovery technology and almost 73% of the operations are without blood transfusions.
Description
Methods: From October 2011 to December 2019, 473 consecutive patients underwent surgical aortic repair of ATAAD at Second Hospital of Jilin University. We divided these patients into two groups: 162 patients with complicated aortic root (34.2%) and 311 patients without complicated aortic root (65.8%). Patients with complicated aortic root were divided into 4 types: 1, aortic sinus diameter < 4.5 cm, but sinotubular junction (STJ) diameter ≥ 4.5 cm, 24 patients; 2, coronary involvement, including Neri. type A, B and C8, 86 patients; 3, aortic sinus diameter ≥ 4.5 cm with significant dilatation in the non-coronary sinus only, 19 patients; 4, aortic sinus diameter ≥ 4.5 cm with Marfan syndrome or other hereditary thoracic aortic disorder, or aortic sinus diameter ≥ 5.0 cm and excessive dilatation of the aortic root involving two or three sinuses of Valsalva, 33 patients; respectively (Figure 1). We focused on assessing the therapeutic efficacy of Liu's aortic root repair strategy in the 162 patients.
Results: 33 patients received Modified Bentll procedure for aortic root aneurysm, and the remaining 129 patients were performed Liu's aortic root repair. In addition, 24 patients received coronary artery bypass surgery for Neri. type C coronary involvement. Overall in-hospital mortality was 5.6%. The 1-year, 3-year, and 5-year survival estimates were 90.7%, 84.5%, and 80.6%, respectively. At a median follow-up of 48.2 (interquartile range, 23.1-67.7) months, all patients were free from reoperation for aortic root disease, such as: recurrent aortic root dissections, residual false lumens in the aortic root, aortic root pseudoaneurysms, and severe aortic regurgitation.
Conclusions: In type A aortic dissection with complicated aortic root except aortic root aneurysm, Liu's aortic root repair is a safe and effective surgical strategy that achieves favorable outcomes.
Authors
kexiang liu (1), maoxun huang (2)
Institutions
(1) N/A, Jilin, Jilin, (2) Second Hospital of Jilin University, changchun, jilin province