Stanford A 型急性大動脈解離手術成績向上に向けて―臓器灌流障害に対する戦略

Objectives：We presented the results of surgery for Stanford type A acute aortic dissection at our hospital and described strategies for organ malperfusion （especially brain malperfusion）. Results：From January 2012 to December 2019, we underwent 174 patients of Stanford type A acute aortic dissection at our hospital. There were 47 patients（ 27.0％） with postoperative cerebral infarction （stroke group）. Compared to the non-stroke group, the stroke group had significantly more cases of persistent central nervous system malperfusion before surgery and had more intraoperative bleeding and blood transfusion. The hospital mortality was 23.4％ in the stroke group and 3.9％ in the non-stroke group（ p＜0.001）. As a result of multivariate analysis, risk factors for hospital mortality were preoperative endotracheal intubation, long-term cardiopulmonary bypass time and postoperative stroke. The risk factor for postoperative stroke was preoperative central nervous system malperfusion. Conclusions：As a strategy for cerebral malperfusion, it is useful to use the right axillary artery blood supply and the isolated cerebral perfusion method.