Modified Bentall Procedure for the Treatment of Stanford Type A<sub>3</sub> Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

INWei , HUANGFu-hua ,  CHENXin , LIUSheng-chen

Department of Thoracic and Cardiovascular Surgery, Nanjing Cardiovascular Disease Hospital, Nanjing First Hospital, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing 210006, P. R. China;

Corresponding?author：

CHENXin, Email: stevecx@sina.com

Keywords：

Aortic dissection; Bentall procedure; Modification; Efficacy

DOI：

10.7507/1007-4848.20140209

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A₃ aortic dissection (AD). Methods Fifty-four patients with Stanford type A₃ AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. Results There was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. Conclusion Modified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.

Citation： INWei, HUANGFu-hua, CHENXin, LIUSheng-chen. Modified Bentall Procedure for the Treatment of Stanford Type A₃ Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 725-729. doi: 10.7507/1007-4848.20140209 Copy

1.	Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1):311-328.
2.	徐志云, 鄒良建, 宋智鋼, 等. Stanford A型主動脈夾層外科手術方法和療效.中華胸心血管外科雜志, 2007, 23(5):295-297.
3.	陳鑫, 黃福華, 徐明, 等.孫氏手術治療急性Stanford A型主動脈夾層.中華胸心血管外科雜志, 2012, 28(6):333-335.
4.	邱志兵, 陳鑫, 徐明, 等.急性Stanford A型主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2007, 14(6):426-428.
5.	孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43(18):1171-1176.
6.	Chen X, Huang FH, Xu M, et al. The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11(5):594-598.
7.	孫立忠, 劉寧寧. Bentall手術.中華胸心血管外科雜志, 2012, 28(12):761-768.
8.	Gott VL, Cameron DE, Alejo DE, et al. Aortic root replacement in 271 Marfan patients:A 24-year experience. Ann Thorac Surg, 2002, 73(2):438-443.
9.	Houel R, Soustelle C, Kirsch M, et al. Long-term results of the Bentall operation versus separate replacement of the ascending aorta and aortic valve. J Heart Valve Dis, 2002, 11(4):485-491.
10.	蘭懷, 王輝山, 韓宏光, 等. Bentall手術治療馬方綜合征的療效分析.中國胸心血管外科臨床雜志, 2013, 20(1):100-102.
11.	孫立忠, 劉寧寧, 常謙, 等.主動脈手術并同期冠狀動脈旁路移植術的臨床總結.中華外科雜志, 2006, 44(2):76-79.
12.	Milano AD, Pratali S, Mecozzi G, et al. Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg, 2003, 75(6):1797-1801.
13.	Chwan NA, Yiannikas J, Chiang YA, et al. Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography. J Cardiovasc Comput Tomogr, 2010, 4(3):206-212.
14.	Erkut B, Ceviz M, Becit N, et al. Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography. Heart Surg Forum, 2007, 10(3):e191-e192.
15.	李羅成, 王志維, 吳紅兵, 等. Stanford A型主動脈夾層手術中的主動脈根部處理.中華胸心血管外科雜志, 2011, 27(6):331-333.
16.	Urbanski PP, Heinz N, Zhan X, et al. Modifi ed bio-Bentall procedure:10-year experience. Eur J Cardiothorac Surg, 2010, 37(6):1317-1321.
17.	Kim TS, Na CY, Oh SS, et al. Long-Term mortality and morbidity after button bentall operation. J Card Surg, 2013, 28(3):280-284.
18.	Joo HC, Chang BC, Youn YN, et al. Clinical experience with the Bentall procedure:28 years. Yonsei Med J, 2012, 53(5):915-923.
19.	Verbakel KM, van Straten AH, Hamad MA, et al. Results of one-hundred and seventy patients after elective Bentall operation. Asian Cardiovasc Thorac Ann, 2012, 20(4):418-425.
20.	Westaby S, Katsumata T, Vaccari G. Aortic root replacement with coronary button re-implantation:low risk and predictable outcome. Eur J Cardiothorac Surg, 2000, 17(3):259-265.
21.	秦衛, 黃福華, 肖立瓊, 等.夜間急診主動脈夾層手術并不增加住院死亡率.中國胸心血管外科臨床雜志, 2013, 20(5):542-545.
22.	秦衛, 黃福華, 陳鑫, 等.深低溫停循環聯合順行性腦灌注對患者認知功能的影響.中國胸心血管外科臨床雜志, 2014, 21(1):71-74.

1. Khan IA, Nair CK. Clinical, diagnostic, and management perspectives of aortic dissection. Chest, 2002, 122(1):311-328.
2. 徐志云, 鄒良建, 宋智鋼, 等. Stanford A型主動脈夾層外科手術方法和療效.中華胸心血管外科雜志, 2007, 23(5):295-297.
3. 陳鑫, 黃福華, 徐明, 等.孫氏手術治療急性Stanford A型主動脈夾層.中華胸心血管外科雜志, 2012, 28(6):333-335.
4. 邱志兵, 陳鑫, 徐明, 等.急性Stanford A型主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2007, 14(6):426-428.
5. 孫立忠, 劉寧寧, 常謙, 等.主動脈夾層的細化分型及其應用.中華外科雜志, 2005, 43(18):1171-1176.
6. Chen X, Huang FH, Xu M, et al. The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection:operative result and follow-up. Interact Cardiovasc Thorac Surg, 2010, 11(5):594-598.
7. 孫立忠, 劉寧寧. Bentall手術.中華胸心血管外科雜志, 2012, 28(12):761-768.
8. Gott VL, Cameron DE, Alejo DE, et al. Aortic root replacement in 271 Marfan patients:A 24-year experience. Ann Thorac Surg, 2002, 73(2):438-443.
9. Houel R, Soustelle C, Kirsch M, et al. Long-term results of the Bentall operation versus separate replacement of the ascending aorta and aortic valve. J Heart Valve Dis, 2002, 11(4):485-491.
10. 蘭懷, 王輝山, 韓宏光, 等. Bentall手術治療馬方綜合征的療效分析.中國胸心血管外科臨床雜志, 2013, 20(1):100-102.
11. 孫立忠, 劉寧寧, 常謙, 等.主動脈手術并同期冠狀動脈旁路移植術的臨床總結.中華外科雜志, 2006, 44(2):76-79.
12. Milano AD, Pratali S, Mecozzi G, et al. Fate of coronary ostial anastomoses after the modified Bentall procedure. Ann Thorac Surg, 2003, 75(6):1797-1801.
13. Chwan NA, Yiannikas J, Chiang YA, et al. Coronary ostial morphology after modified Bentall operation assessed with dual-source multidetector computed tomography. J Cardiovasc Comput Tomogr, 2010, 4(3):206-212.
14. Erkut B, Ceviz M, Becit N, et al. Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography. Heart Surg Forum, 2007, 10(3):e191-e192.
15. 李羅成, 王志維, 吳紅兵, 等. Stanford A型主動脈夾層手術中的主動脈根部處理.中華胸心血管外科雜志, 2011, 27(6):331-333.
16. Urbanski PP, Heinz N, Zhan X, et al. Modifi ed bio-Bentall procedure:10-year experience. Eur J Cardiothorac Surg, 2010, 37(6):1317-1321.
17. Kim TS, Na CY, Oh SS, et al. Long-Term mortality and morbidity after button bentall operation. J Card Surg, 2013, 28(3):280-284.
18. Joo HC, Chang BC, Youn YN, et al. Clinical experience with the Bentall procedure:28 years. Yonsei Med J, 2012, 53(5):915-923.
19. Verbakel KM, van Straten AH, Hamad MA, et al. Results of one-hundred and seventy patients after elective Bentall operation. Asian Cardiovasc Thorac Ann, 2012, 20(4):418-425.
20. Westaby S, Katsumata T, Vaccari G. Aortic root replacement with coronary button re-implantation:low risk and predictable outcome. Eur J Cardiothorac Surg, 2000, 17(3):259-265.
21. 秦衛, 黃福華, 肖立瓊, 等.夜間急診主動脈夾層手術并不增加住院死亡率.中國胸心血管外科臨床雜志, 2013, 20(5):542-545.
22. 秦衛, 黃福華, 陳鑫, 等.深低溫停循環聯合順行性腦灌注對患者認知功能的影響.中國胸心血管外科臨床雜志, 2014, 21(1):71-74.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified Bentall Procedure for the Treatment of Stanford Type A₃ Aortic Dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Modified Bentall Procedure for the Treatment of Stanford Type A3 Aortic Dissection

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content

Modified Bentall Procedure for the Treatment of Stanford Type A₃ Aortic Dissection