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Objective: To summarize the experience of surgical treatment of 72 patients with thoracic aortic aneurysms, analyze the risk factors of surgery, surgical treatment strategies. Methods: The group of 72 patients, 58 males and 14 females, aged 16 to 70 years old, with an average age of 46.24 ± 13.10 years. Duration of 8h-6 months 8h 1 cases, 1 to 30 days 42 cases, 30 to 60 days, 10 cases, 2 to June 19 cases. Main cause: 32 cases of aortic dissection, DeBakey Ⅰ 16 cases of aortic dissection, DeBakey II in 7 cases, DeBakey Ⅲ type 9 cases; 19 cases of aortic aneurysm; Marfan syndrome in 16 cases; five cases of descending aortic aneurysm . The above cases with aortic valve regurgitation in 23 cases, the aortic stenosis four cases, Aortic Valve Prolapse two cases, mitral valve regurgitation four cases, two cases of mitral valve prolapse, mitral stenosis, The tricuspid valve severe Close insufficiency in 5 patients, Ebstein two cases of patent ductus arteriosus in two cases, two cases of pulmonary hypertension, pericardial effusion. Thoracic aortic aneurysm ruptured into the pleural two cases of pleural effusion. Coronary heart disease four cases of acute renal failure in 3 patients. The purposes of the the Bentall operation 44 cases including four cases of Bentall surgery combined with mitral valve replacement, Bentall operation combined CABG 3 cases, Bentall operation combined three cases of mitral valvuloplasty Bentall operation combined with Ebstein deformity correction surgery two cases, The Bentall operation the joint right half of the bow resection 1 case. David surgery in nine cases, David surgical aortic joint full arch replacement patients; ascending aorta replacement six cases, combined coronary artery surgery in three cases, joint nearly half arch replacement PDA ligation, combined with total arch replacement cases. Simple ascending aorta three cases resection replacement. Descending aorta surgery 12 cases, including the descending aorta replacement surgery 11 cases drop aortic nourishing piece patch length 10cm. Half-bow resection displacement four cases, nearly half of the bow resection of David surgery two cases, nearly half of the arch replacement Bentall operation, simple semi-arch resection replacement one cases. The full bow resection replacement eight cases, including full the arch resection replacement surgery of the United David five cases of pure aortic arch replacement three cases. Results: 63 patients were discharged. Reoperation hemostasis two cases; postoperative temporary neurological dysfunction 7 cases, recovery after 4 to 15 days, respectively; 1 patient died of intractable ventricular fibrillation Bentall end of surgery, cardiac resuscitation. Coma and death after the two cases, automatically discharged patients, 2 patients with late concurrent renal failure, gastrointestinal bleeding death; acute aortic dissection preoperative acute renal failure, Bentall operation smoothly, postoperative renal failure aggravated 1 died . Descending aorta arthroplasty complicated by paraplegia, automatically discharged patients. The surgery 8 patients died, the mortality rate of 11.11%. Were followed up for 3 months to 11 years, an average of 63 months. The treatment results were satisfactory, no residual leakage pseudoaneurysm. Chinese Abstract Conclusion: The complex thoracic aortic aneurysm surgery, the risk greatly complicated by bleeding, brain injury and spinal copies injury often endanger the patient's life. Wood study results show that taking comprehensive measures to prevent complications and improve surgical treatment. 1. Improve surgical techniques, to strengthen coordination between the surgical staff, earnest and meticulous operation of each technology is the key to prevention of intraoperative bleeding the. Persistent selective subclavian artery cerebral perfusion, in line with the anatomy, physiology, surgical field clear, cerebral protection can be effectively implemented to avoid brain damage, is the preferred brain protection measures of the aortic arch and nearly arch aortic aneurysm surgery. 3.DHCA RCP and the subclavian artery group brain injury and brain injury mortality statistical difference exists: with DHCA RCP brain damage more complications the RCP itself does not meet the physiological perfusion flow, perfusion pressure, and other parameters to be further studied . 4. Improve the level of operative techniques, to strengthen the close cooperation between the surgical staff, 'reduce errors, shorten the operation time, shorter cardiopulmonary bypass time, especially shorter circulatory arrest time is an important measure to reduce postoperative brain damage. 5 surgery to take comprehensive measures to protect the spinal cord, and especially for coarse intercostal artery should be given protection, consistent with artificial vascular replantation is conducive to the maintenance of the spinal cord blood supply, the prevention of paraplegia. Aortic acute dissection with acute renal dysfunction should emergency surgery to relieve renal ischemia caused by the primary disease quickly, so that the recovery of renal function, or the patient may appear due to aggravation of renal ischemia irreversible renal renal failure and death emergency surgery, however, a higher mortality rate.
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