Redo Total Aortic Arch Replacement in Patients with Aortic Dissection After Open-Heart Surgery and Long-Term Follow-Up Results

ABSTRACT Introduction: The objectives of this study were to investigate the main treatment strategies and long-term follow-up results of aortic dissection surgery after open-heart surgery (ADSOHS) and to analyze the risk factors that cause ADSOHS. Methods: One hundred thirty-seven patients with ADSOHS hospitalized in our hospital from January 2009 to December 2018 were selected as the research object. Long-term follow-up results, complications, mortality, and changes of cardiac function before and after operation were used to explore the value of Sun’s operation. Results: The length of stay in intensive care unit of these 137 patients ranged from 9.5 to 623.75 hours (average of 76.41±97.29 hours), auxiliary ventilation time ranged from 6.0 to 259.83 hours (average of 46.16±55.59 hours), and hospital stay ranged from six to 85 days (average of 25.06±13.04 days). There were seven cases of postoperative low cardiac output, 18 cases of coma and stroke, and six cases of transient neurological dysfunction. A total of 33 patients died; 19 patients died during the perioperative period, 18 died during Sun’s operation and one died during other operation; and 14 patients died during follow-up (January 2021), 12 cases of Sun’s operation and two cases of other operations. Conclusion: ADSOHS treatment strategy is of high application value, and the risk of neurological complications and mortality is low. The main risk factors are postoperative low cardiac output, coma, stroke, and transient neurological dysfunction. The extracorporeal circulation time is relatively long. Short- and long-term follow-up effects are good, and it is worthy of clinical promotion.摘要 引言：本研究旨在探讨心脏直视手术后主动脉夹层手术（aortic dissection surgery after open-heart surgery，ADSOHS）的主要治疗策略与长期随访结果，并分析导致ADSOHS的危险因素。 方法：选取2009年1月至2018年12月于我院住院的137例ADSOHS患者作为研究对象。基于长期随访结果、并发症发生情况、死亡率及手术前后心功能变化，探讨孙氏手术（Sun’s operation）的临床应用价值。 结果：137例患者的重症监护病房停留时长为9.5~623.75小时，平均（76.41±97.29）小时；辅助通气时长为6.0~259.83小时，平均（46.16±55.59）小时；住院时长为6~85天，平均（25.06±13.04）天。术后发生低心排血量7例、昏迷与脑卒中18例、一过性神经功能障碍6例。共计33例患者死亡：围手术期死亡19例，其中孙氏手术相关死亡18例、其他手术相关死亡1例；随访至2021年1月时，随访阶段死亡14例，其中孙氏手术相关12例、其他手术相关2例。 结论：ADSOHS治疗策略具有较高的临床应用价值，其神经系统并发症与死亡率风险较低。主要危险因素为术后低心排血量、昏迷、脑卒中及一过性神经功能障碍，且体外循环时长相对较长。该术式短期与长期随访效果均良好，值得临床推广应用。