A型主动脉夹层的手术方法

                               
登录/注册后可看大图

Type A Dissection Repair, Ascending Aorta Replacement and Aortic Root Valve Sparing Repair (Florida Sleeve)

History:
This patient is a 55-year-old male who presented with type A aortic dissection. He has a history of a type B aortic dissection with subsequent repair of descending aorta and unrepaired abdominal aorta.

Procedure:
Midline sternotomy was performed, then the right infraclavicular incision was done and the right subclavian artery was cannulated via the graft. Right atrium was cannulated to establish the cardiopulmonary bypass. The patient was cooled down to 20 degrees of Celsius and deep hypothermic circulatory arrest was initiated. The aorta was opened, the clot was removed and antegrate cerebral perfusion was initiated via the left carotid artery. Then, the 26mm graft was anastomosed to the aorta 1 cm proximal to brachiocephalic artery, the graft was clamped and the rewarming of the patient was initiated. The root was transected 1cm above the sinotubular junction, the dissection at the non coronary and the right coronary sinus were repaired with pieces of Teflon between the initima and the adventitia and secured with BioGlue. Slits were created on the 38mm graft, so it could accommodate the coronary arteries and it was secured into place with Cor-Knot device. Then this graft was cut to the height of sinotubular junction and it was anastomosed to the aorta in a continuous fashion. The 26mm graft was brought into the field and anastomosed to the Florida-sleeve-graft aorta. The patient was closed in a standard fashion and had an uneventful hospital course.

This technique allows to perform aortic root dissection repair, sparing the aortic root and valve, thus reducing the risk of complications, associated with reanastamosis of coronary buttons and significantly decreasing the bypass time.