Strategy of cardiopulmonary bypass for Stanford type A aortic dissection

Objective:To summarize the management of cardiopulmonary bypass(CPB) for Stanford type A aortic dissection. Method:One hundred and sixty-five patients with Stanford type A aortic dissection underwent Wheat,David,Bentall and total aortic arch replacement procedure with slight hypothermia,deep hypothermic circulatory arrest(DHCA) and selective antegrade cerebra perfusion(SACP) respectively.Cannulation of right subclavian artery and right atrial were done to establish CPB in total aortic arch replacement procedure,and distal aortic arch aneurysm stent grafting and arch anastomosis under DHCA and SACP,and the flow rate o f SACP was maintained with 5~10 ml/(kg·min) during DHCA.We used the technique of double arterial lines with single pump head and unilateral selective cerebra perfusion,α+pH-stat,hyperoxia management and ultrafiltration in total aortic arch replacement procedure. Result:Mean CPB time was(197.3±28.3)min,and mean aortic clamp time was(86.1±10.8)min.Mean duration of SACP was(45.2±7.7)min,and mean DHCA time was(25.3±3.8)min,mean ICU stay time was 72-516 hours(181.31 h).Hospital mortality in this group was 11.26%(17/ 151).Seventeen patients died of multiorgan failure,and one hundred and thirty four patients survived and disch-arged from hospital with heart function NYHAⅠ-Ⅱ. Conclusion:Using suitable management of CPB could obtain satisfactory clinical survival rate in patients of Stanford type A aortic dissection.The techniques of double arterial lines with single pump head and unilateral selective cerebra perfusion,α+pH-stat,hyperoxia management and ultrafiltration are safe and effective methods for total aortic arch replacement.