Single-center analysis of David I versus Bentall's procedure for acute aortic dissection

doi:10.3969/j.issn.1004-583X.2024.05.006

Abstract

Abstract:

Objective A single-center analysis of the efficacy of David I versus Bentall procedure for acute aortic dissection was conducted. Methods A total of 28 patients with acute aortic dissection hospitalized in the Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were enrolled. According to the surgical methods, they were divided into David I group (n=13, received David I procedure ) and Bentall group (n=15, received Bentall’s procedure). After 1 year of follow-up, the inter-group perioperative indexes, cardiac indexes and complications were assessed. Results The operation time, transfer time and aortic occlusion time were significantly longer in David I group versus Bentall group (P<0.05). There were no significant differences in intraoperative blood loss, 24 h postoperative drainage volume, ventilator-assisted time, intensive care unit stay time, and hospitalization time in David I group versus Bentall group (P>0.05). There was no significant inter-group difference in left ventricular ejection fraction (LVEF), maximum diameter of ascending aorta and left ventricular end-diastolic diameter (LVDD) before operation and on year 1 of operation (P>0.05). LVEF in David I group was significantly decreased on year 1 of operation than that before operation (P<0.05), and maximum diameter of ascending aorta and LVDD were significantly decreased on year 1 of operation in the both groups than those before operation (P<0.05). There was no inter-group significant difference in the incidence of complications (46.1% vs 46.7%, P>0.05). Conclusion There was no significant difference in postoperative survival rate and valvular complications between Bentall and David Ⅰ procedure in the treatment of acute aortic dissection. The Bentall procedure has a shorter operating time, transit time, and aortic occlusion time.

Key words: aortic dissection, David Ⅰ surgery, Bentall surgery, curative effect

CLC Number:

R543.1

Liu Yang, Ma Ning, Zhang Weihua. Single-center analysis of David I versus Bentall's procedure for acute aortic dissection[J]. Clinical Focus, 2024, 39(5): 420-425.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.05.006

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I5/420

Figures/Tables 7

References 19

[1]	Jankovic N, Matkovic M, Bilbija I, et al. The clinical impact of the extension of acute type A aortic surgery on long-term outcomes: Should we tend to be conservative?[J]. Medicina (Kaunas), 2023, 60(1):35.
[2]	Nardi P, Pisano C, Bassano C, et al. Bentall operation: Early surgical results, seven-year outcomes, and risk factors analysis[J]. Int J Environ Res Public Health, 2022, 20(1):212.
[3]	Aoyama T, Kunisawa S, Fushimi K, et al. Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients[J]. J Cardiothorac Surg, 2018, 13(1):129. doi: 10.1186/s13019-018-0814-6 pmid: 30563552
[4]	lsayed RS, Cohen RG, Fleischman F, et al. Acute type A aortic dissection[J]. Cardiol Clin, 2017, 35(3):331-345. doi: S0733-8651(17)30023-1 pmid: 28683905
[5]	周永智, 魏翔, 邓朋, 等. 经胸骨上段小切口行A型主动脉夹层手术[J]. 临床外科杂志, 2023, 31(3):238-241.
[6]	Stonko DP, Bose S, Mcdermott K, et al. Association of year of surgery and carotid stenting outcomes in high-risk patients, 2015-2021[J]. JAMA surgery, 2023(7):158.
[7]	De León Ayala IA, Chen YF. Acute aortic dissection: An update[J]. Kaohsiung J Med Sci, 2012, 28(6):299-305.
[8]	薛云星, 周庆, 潘俊, 等. 双马甲包裹法根部重建技术用于急性A型主动脉夹层的近端修复[J]. 中华胸心血管外科杂志, 2021, 37(4):212-215.
[9]	Fang C, Gao S, Ren X, et al. Comparison of two techniques in proximal anastomosis in acute type A aortic dissection[J]. Front Cardiovasc Med, 2022, 9:1047939.
[10]	Erbel R, Aboyans V, Boileau C, et al. 2014 ESCguidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of thethoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2014, 35(41): 2873-2926.
[11]	范舒雅, 丘俊涛, 戴路, 等. 外膜内翻技术在急性A型主动脉夹层根部修复的短期及中远期效果[J]. 中华胸心血管外科杂志, 2022, 38(5):266-271.
[12]	罗黎, 解鑫隆. 主动脉弓去分支杂交手术治疗Stanford A型主动脉夹层的疗效分析[J]. 中国现代手术学杂志, 2022, 26(4):286-289.
[13]	葛翼鹏, 里程楠, 钟永亮, 等. 急性Stanford A型主动脉夹层中低温停循环手术围手术期大量出血的危险因素分析[J]. 中华胸心血管外科杂志, 2021, 37(5):281-285.
[14]	周越赟, 王晓棣, 黄福华. 全弓置换术与右半弓置换术治疗急性DeBakeyⅠ型主动脉夹层患者围术期效果和远期预后的研究进展[J]. 实用心脑肺血管病杂志, 2023, 31(7):131-134.
[15]	金刚, 李超, 王薇, 等. 胸主动脉腔内修复术对比药物和外科手术治疗B型主动脉夹层的死亡率和生存率的系统评价和Meta分析[J]. 中国循证心血管医学杂志, 2023, 15(1):3-7.
[16]	范舒雅, 畅怡, 郭宏伟, 等. 主动脉根部袖状包裹技术在改良Bentall手术中应用的近期疗效[J]. 中华胸心血管外科杂志, 2021, 37(9):550-552.
[17]	Leontyev S, Schamberger L, Davierwala PM, et al. Early and late results after David vs Bentall procedure: A propensity matched analysis[J]. Ann Thorac Surg, 2020, 110(1):120-126. doi: S0003-4975(19)31758-8 pmid: 31786286
[18]	Li Q, Li B, Xi S, et al. Experience with aortic arch inclusion technique using artificial blood vessel for type A aortic dissection: An application study[J]. J Cardiothorac Surg, 2024, 19(1):189.
[19]	Velayudhan B, Ibrahim M, Idhrees M. Surgical techniques in acute type A aortic dissection: How we do it[J]. Asian Cardiovasc Thorac Ann, 2023, 31(1):5-7.

组别		例数	年龄 (岁)			性别[例(%)]				体质量指数 (kg/m²)			破口位置[例(%)]
组别		例数	年龄 (岁)			男		女		体质量指数 (kg/m²)			升主动脉		主动脉弓		降主动脉
DavidⅠ组		13	43.85±8.61			13(100.0)		0		27.30±3.82			10(76.9)		3(23.1)		0
Bentall组		15	41.87±13.02			12(80.0)		3(20.0)		25.55±3.99			12(80.0)		1(6.7)		2(13.3)
t/χ²值			0.466			2.912				1.177			3.055
P值			0.645			0.088				0.25			0.217
组别	主动脉反流程度[例(%)]						糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
组别	1级			2级	3级		糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
DavidⅠ组	4(30.8)			6(46.2)	3(23.0)		0		6(46.1)		2(15.4)	1(7.7)		0		6(46.2)		7(53.9)
Bentall组	3(20.0)			3(20.0)	9(60.0)		2(13.3)		5(33.3)		5(33.3)	1(6.7)		1(6.7)		4(26.7)		5(33.3)
t/χ²值	4.021						1.867		0.48		1.197	0.011		0.899		1.152		1.197
P值	0.134						0.172		0.488		0.274	0.916		0.343		0.283		0.274

组别		例数	年龄 (岁)			性别[例(%)]				体质量指数 (kg/m²)			破口位置[例(%)]
组别		例数	年龄 (岁)			男		女		体质量指数 (kg/m²)			升主动脉		主动脉弓		降主动脉
DavidⅠ组		13	43.85±8.61			13(100.0)		0		27.30±3.82			10(76.9)		3(23.1)		0
Bentall组		15	41.87±13.02			12(80.0)		3(20.0)		25.55±3.99			12(80.0)		1(6.7)		2(13.3)
t/χ²值			0.466			2.912				1.177			3.055
P值			0.645			0.088				0.25			0.217
组别	主动脉反流程度[例(%)]						糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
组别	1级			2级	3级		糖尿病 [例(%)]		高血压 [例(%)]		脑梗死 [例(%)]	心肌缺血 [例(%)]		肠道缺血 [例(%)]		吸烟史 [例(%)]		饮酒史 [例(%)]
DavidⅠ组	4(30.8)			6(46.2)	3(23.0)		0		6(46.1)		2(15.4)	1(7.7)		0		6(46.2)		7(53.9)
Bentall组	3(20.0)			3(20.0)	9(60.0)		2(13.3)		5(33.3)		5(33.3)	1(6.7)		1(6.7)		4(26.7)		5(33.3)
t/χ²值	4.021						1.867		0.48		1.197	0.011		0.899		1.152		1.197
P值	0.134						0.172		0.488		0.274	0.916		0.343		0.283		0.274

组别	例数	手术时间 (min)	转机时间 (min)	主动脉阻断时间(min)	术中出血量 (ml)	术后24 h 引流量(ml)	呼吸机辅助时间(h)	ICU停留时间 (h)	住院时间 (d)
DavidⅠ组	13	506.38±65.47	241.62±48.55	197.15±46.51	607.69±394.68	694.62±289.73	90.27±40.68	109.00±54.03	18.46±10.13
Bentall组	15	438.53±95.87	190.27±47.86	131.60±34.80	600.00±742.58	645.33±299.16	76.67±34.73	84.33±41.74	13.14±4.87
t值		2.151	2.812	4.258	0.048	0.441	0.960	1.358	1.814
P值		0.041	0.009	<0.01	0.962	0.663	0.346	0.186	0.081

组别	例数	手术时间 (min)	转机时间 (min)	主动脉阻断时间(min)	术中出血量 (ml)	术后24 h 引流量(ml)	呼吸机辅助时间(h)	ICU停留时间 (h)	住院时间 (d)
DavidⅠ组	13	506.38±65.47	241.62±48.55	197.15±46.51	607.69±394.68	694.62±289.73	90.27±40.68	109.00±54.03	18.46±10.13
Bentall组	15	438.53±95.87	190.27±47.86	131.60±34.80	600.00±742.58	645.33±299.16	76.67±34.73	84.33±41.74	13.14±4.87
t值		2.151	2.812	4.258	0.048	0.441	0.960	1.358	1.814
P值		0.041	0.009	<0.01	0.962	0.663	0.346	0.186	0.081

组别	例数	LVEF(%)		升主动脉最大内径(mm)		LVDD(mm)
组别	例数	术前	术后1年	术前	术后1年	术前	术后1年
DavidⅠ组	13	61.54±4.18	55.23±10.41^*	48.00±6.84	28.92±1.32^*	55.23±5.53	48.31±3.23^*
Bentall组	15	59.87±3.64	58.77±6.53	52.21±8.46	28.54±2.63	57.50±7.98	48.38±6.01^*
t值		1.131	-1.092	-1.434	0.475	-0.860	-0.039
P值		0.268	0.285	0.164	0.639	0.397	0.969