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摘要:
目的 Cabrol手术由Cabrol C教授于1981年首创，但至今关于该术式用于治疗A型主动脉夹层的报道并不多。本研究对我中心近7年来应用Cabrol术式治疗急性A型主动脉根部病变的病例进行总结。 方法 2009年1月~2016年12月，共有47例急性A型主动脉夹层的患者在我中心接受Cabrol手术治疗。所有病例术前均经心脏彩超及主动脉增强CT检查确诊。对其根部病变应用Cabrol技术处理，弓部病变采用半弓置换或全弓置换。对所有病例的相关数据进行回顾性分析。 结果 总共纳入47例患者，其中6例为单纯Cabrol手术，13例为Cabrol+右半弓置换，28例为Cabrol+孙氏手术。总的30 d死亡率为10.6%（5/47）。住院期间急性肾功能衰竭发生率25.5%（12/47），有12.8%（6/47）的病人需要接受连续肾脏替代治疗。中位住院时间为25.5 d（15~128 d），随访时间6~36月。 结论 Cabrol手术用于急性A型主动脉夹层的病人根部处理安全有效，术中部分技术细节需要注意。 Abstract:Objective Cabrol procedure was introduced by Professor Cabrol C in 1981, but little information existed regarding the results of Cabrol technique in aortic dissection(AD). This study explored a 7-year period results of aortic root replacements in type A aortic dissection employing this procedure. Methods From January 2009 to December 2016, 47 patients with type A aortic dissection received Cabrol procedure in our hospital. All patients received echocardiography and CT scan of whole aorta before operation. Cabrol procedure was performed to repair the aortic root. The replacement of right hemi aortic arch or total aortic arch and a stented frozen elephant trunk implantation might be performed based on the extent of the dissection in the aortic arch. A retrospective analysis was performed to evaluate the effectiveness of this procedure in type A aortic dissection. Results Forty-seven cases were admitted, including 6 cases of simple Cabrol procedure, 13 cases with concomitant replacement of right hemi aortic arch and 28 cases with concomitant total aortic arch replacement and frozen elephant trunk technique.The 30-day mortality was 10.6%(5/47). 25.5%(12/47) of patients developed acute renal failure, and 12.8%(6/47) needed continuous renal replacement therapy (CRRT) during hospital time. The median hospital time were 25.5 d, ranging from 15 to 128 d.It followed-up from 6 to 36 months. Conclusion The Cabrol procedure is feasible and safe for patients with type A aortic dissection. The artificial blood vessels are unobstructed. -
Key words:
- aortic dissection /
- surgical procedure /
- cabrol procedure
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Table 1. Clinical characteristics of patients (n=47)
Data [cases (%)/ ( $\bar x \pm s$ )]Male 40 (85.1%) Female 7 (14.9%) Age (year) 48.2±10.6 Interval time between disease onset and surgery (d) 13.4±25.6 Staging phase Acute phase 17 (36.2%) Sub-acute phase 20 (42.6%) Chronic phase 10 (21.3%) Hypertension 27 (57.4%) Pericardium effusion or cardiac tamponade 5 (10. 6%) Left heart failure 1 (2.1%) Syncope 1 (2.1%) History of cardiac surgery 1 (2.1%) Diameter of the ascending aorta (mm) 47.3±8.4 mm Diameter of the aortic sinus (mm) 43.4±8.5 mm Area of aortic valve insufficiency (cm2) 5.0±4.4 cm2 Grade of aortic valve insufficiency None 6 (12.8%) Mild 18 (38.3%) Moderate 9 (19.1%) Severe 14 (29.8%) Normal LVEF (n) 35 (74.5%) Emergency operation (within 6 h after admission) 11 (23.4%) 
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Table 2. Data of early deaths (within 30 days) in hospital
Preoperative complication Interval time* (day) Emergency surgery Procedures Cause of death Hypertension 7 No Cabrol+TAR*+FET*+CABG LCOS* Hypertension 1.9 No Cabrol+TAR+FET+CABG MODS* Hypertension 4.3 Yes Cabrol+TAR+FET MODS and bleeding Hypertension 1.5 No Cabrol+TAR+FET Rupture of abdominal aorta Hypertension 2.5 No Cabrol+TAR+FET MODS *Interval time means time between disease onset and surgery*TAR means total arch replacement*FET means frozen elephant trunk*LCOS means low cardiac output syndrome*MODS means multiple organ dysfunction syndrome.
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