CÁC TIẾN BỘ TRONG PHẪU THUẬT ĐIỀU TRỊ BÓC TÁCH ĐỘNG MẠCH CHỦ LOẠI A THEO STANFORD CẤP TÍNH TẠI BỆNH VIỆN CHỢ RẪY

Abstract

Background: Acute thoracic aortic dissection (ATAD) is associated with very high morbidity and mortality despite appropriate treatment. Acute Stanford A dissection, especially, is the most catastrophic clinical form of ATAD. Surgery is the gold standard treament of this disease. At Cho Ray hospital, we have been performing surgery to treat this disease for decades. With the continuous improvement in terms of technique and treatment strategy at Cho Ray hospital, we always question that whether the early results in treament of this disease have achieved any improvement? And what fators could influent those results? Methods: This study retrospectively evaluated patients underwent surgery for acute Stanford type A aortic dissection between January 2020 and December 2022 at Cardiac surgery department. Results: A total of 122 patients were included in this study. Patients were predominantly men (2,57 males/female) with mean age of 54,26± 12,49 years. Before surgery, 3 cases received pericardial drainage due to tamponade and vasopressors, 1 case received CPR for CPA. Mean EF=61 ± 9,4%.Mean aortic cross-clamp time and mean cardiopulmonary bypass time were, respectively, 133,86± 72,09 minutes and 218,46 ± 80,15 minutes. Total aortic arch replacement surgery accounts for 64%, surgery involving aortic root (Bentall or David procedure) accounts for 23%. 1 case required ECMO after surgery. Post-operative complications included: pneumonia in 22 cases (18,03%), renal failure required dialysis in 8 cases (6,56%), cerebral infarction in 10 cases (8,02%), reoperation for bleeding (6,56%). Mortality rate was 7,34% (9 cases). Conclusion: Acute thoracic aortic dissection (ATAD) is associated with very high morbidity and mortality despite appropriate treatment. Cho Ray Hospital has performed this surgery for decades and has achieved remarkable results recently, with a perioperative mortality rate (7.34%) and early complications comparable to major centers around the world