Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Surgical Treatment of Aortic Dissection Involving Ascending Aorta

상행대동맥을 포함한 대동맥박리에 대한 외과적 치료

  • 유영선 (계명대학교 의과대학 흉부외과학교실) ;
  • 김경렬 (계명대학교 의과대학 흉부외과학교실, 계명대학교 의과대학 흉부외과학교실, 계명대학교 의과대학 흉부외과학교실, 계명대학교 의과대학 흉부외과학교실, 동국대학교 의과대학 부속 포항병원 흉부외과학교실)
  • Published : 1996.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

From January 1989 to July 1995, 18 patients underwent aortic repair for type A dissections. The e were 9 male and 9 female patients aged 41 to 68 years(mean, 53.8). Thirteen patients underwent the procedure during the acute period, and 5 during the chronic period. During repair of acute dissection, procedures included graft replacement of the ascending aorta only (6 patients), ascending aorta plus partial aortic arch (3), ascending aorta plus total aortic arch (2), Bentall's operation (1), and Bentall's operation plus total aortic arch (1). During repair of chronic dissection, procedures included Bentall's operation (3 patients), ascending aorta only (1), and ascending aorta plus partial aortic arch (1). During repair of the arch, antegrade cerebral perfusion was applied in 4 patients and hypothermic circulatory arrest in 3 patients. There were 4 operative deaths(22.2%), 2 of hemorrhage. and 2 of left ventricular failure in the operating room. Follow-up has been 100% completed and ranged from 2 to 53 months (mean, 17 months). One late death resulted from sepsis following secon operation. Thirteen of the survivors are doing well.

1989년 1월부터 1995년 7월까지 상행대동맥 박리환자 18례에 대한 교정수술을 시 행하였다. 남여비는 9 : 9였으며 연령분포는 41세부터 68세까지로 53.8세 였다. 급성박리가 13례, 만성박리가 5례 였다. 수술방법은 급성 13례에서 상행대동맥만 치환한 경우가 6례, 상행대동맥과 대동맥궁 일부를 치환 한 례가 3례, 상행대동맥과 대동맥궁 전부를 치환한 례가 1례, Bentall 술식이 1례, Bentall 술식 에 대동맥 궁 전부를 치환한 례가 1례 있었다. 만성 5례중 Bentall 술식을 시행한 경우가 3례, 상행대동맥을 치환한 경우가 1례, 상행대동맥 에 대동맥궁 일부를 치환한 례가 1례 있었다. 대동맥궁 교정수술을 시행한 환자 7례중 4례에서 선택적 뇌관류법을 시행하였고 3례에서 완전 순환차단법을 시행하였다. 18례중 급성에 서만 4례 사망하여 수술사망율은 22.2%였다. 사망원인은 출혈이 2례, 좌심실부전이 2례였다. 생존환자 14례를 술후 평균 17개월 외래추적하였으며 이중 1례에서 재수술후 2개월째 패혈증으로 사망하였고 나머지 환자는 양호한 편이다.

Keywords

References

  1. Am J Cardiol v.30 Aortic dissections and dissecting aneurysms Anagnostopoulos,C.E.;Prabhakar,M.J.S.;Kittle,C.F.
  2. Ann Surg v.142 Surgical consideration of dissecting aneurysm of the aorta DeBakey,M.E.;Cooley,D.A.;Creech,O.
  3. J Card Surg v.7 Cerebral consequences of hypothermic circulatory arrest in adults Griepp,E.B.;Griepp,R.B.
  4. J Cardiovasc Surg v.31 Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion Ueda,Y.;Miki,S.;Kusuhara,K.;Okita,Y.;Tahata,T.;Yamanaka,K.
  5. J Thorac Cardiovasc Surg v.102 Aortic dissection resulting from tear of transverse arch: Is concomitant arch repair warranted? Yun,K.L.;Glower,D.D.;Miller,D.C.(et al.)
  6. J Thorac Cardiovasc Surg v.104 Surgery for acute dissection of ascending aorta. Should the arch be included? Crawford,E.S.;Kirklin,J.W.;Naftel,D.C.;Svensson,L.G.;Coselli,J.S.;Safi,H.J.
  7. New Engl J Med v.317 Aortic dissection DeSanctis,R.W.;Dodoghazi,R.M.;Austen,W.G.;Buckley,M.J.
  8. Ann Thorac Surg v.50 Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients Roberts,C.S.;Roberts,W.C.
  9. Circulation v.84 no.SUP.3 Surgery extended into the aortic arch in acute type A dissection: indications, techniques, and results Heinemann,M.;Laas,J.;Jurmann,M.;Karck,M.;Borst,H.G.
  10. Ann Thorac Surg v.46 Extended and total aortic resection in the surgical treatment of acute type A aortic dissection: experience with 54 patients Massimo,C.G.;Presenti,L.F.;Marranci,P.(et al.)
  11. J Thorac Cardiovasc Surg v.107 Hypothermic circulatory arrest in operations on the thoracic aorta: determinants of operative mortality and neurologic outcome Ergin,M.A.;Galla,J.D.;Lansman,S.L.;Quintana,C.;Bodian,C.;Griepp,R.B.
  12. Ann Thorac Surg v.32 Surgical treatment of aneurysms of the transverse aortic arch: experience with 25 patients using hypothermic techniques Cooley,D.A.;Ott,D.A.;Frazier,O.H.;Walker,W.E.
  13. J Thorac Cardiovasc Surg v.78 Operative treatment of aortic dissections: experience with 125 patients over a sixteen-year period Miller,D.C.;Stinson,E.B.;Oyer,P.E.(et al.)
  14. J Thorac Cardiovasc Surg v.102 Preservation of aortic valve in type A aortic dissection complicated by aortic regurgitation Fann,J.I.;Glower,D.D.;Miller,D.C.(et al.)
  15. J Thorac Cardiovasc Surg v.92 Eleven year experience with composite graft replacement of the ascending aorta and valve Kouchoukos,N.T.;Marshall,W.G.;Wedige-Stecher,T.A.
  16. Surgery v.92 Dissection and dissecting aneurysms of the aorta: Twenty-seven patients treated surgically DeBakey,M.E.;McCollin,C.H.;Crawford,E.S.(et al.)
  17. J Cardiovasc Surg(Torino) v.31 Surgery of type A acute aortic dissection with gelatin resorcine formol biological glue. A twelve year experience Bachet,J.;Goudot,B.;Teodori,G.(et al.)
  18. Circulation v.72 no.SUP.Ⅱ Acute and chronic aortic dissections.: Determinants of long-term outcome of operative survivors Haverich,A.;Miller,D.C.;Scott,W.C.(et al.)
  19. 대흉외지 v.21 대동맥 박리증의 수술요법 김진국;안혁
  20. 대흉외지 v.27 대동맥궁 절제술의 임상적 고찰 김경환;안혁