Primera aplicación de stent doble rama en cirugía aórtica en China

Author: Professor Xie Baodong, Reviewer: Not specified, Commissioner: Not specified, Organization: Harbin Medical University Affiliated Hospital. Title: First Application of Double Branch Stent in Aortic Surgery in China. Profile: The Harbin Medical University Affiliated Hospital successfully performed the first national surgery with a double branch stent in the aorta.

Recently, Professor Xie Baodong from the Department of Cardiovascular Surgery at the First Affiliated Hospital of Harbin Medical University led a team that successfully implanted a double branch aortic stent system in a 73-year-old patient with acute type A Stanford aortic dissection. This procedure represents the first clinical application of this type of stent in the country and provides a new treatment option for elderly patients with acute aortic dissection in emergencies.

The patient is a 73-year-old man who was admitted due to an acute outcome of aortic dissection. Preoperative examinations revealed that the dissection had a wide extent, affecting the ascending aorta, aortic arch, and descending aorta down to the abdominal aorta, involving multiple major vascular branches, indicating a high surgical complexity. During the operation, disease progression was confirmed with approximately 200 ml of hematoma in the pericardial cavity, significantly aggravated compared to preoperative images, suggesting a high risk of rupture. The ascending aorta showed marked dilation and took on a purplish-blue color, clearly indicating the formation of aortic dissection. The perforation was located at the aortic root, about 1 cm above the right margin of the aortic valve, which maintained reasonably adequate opening and closing function.

After thorough evaluation, the surgical team decided to utilize the double branch intraoperative stent system alongside traditional standard ascending aortic replacement and total arch reconstruction techniques to achieve simultaneous reconstruction of the arch and descending aorta. This approach optimizes the overall surgical process while ensuring treatment completeness. The double branch stent system was implanted during surgery, and the distal end of the artificial blood vessel was nested into the proximal end of the stent's artificial blood vessel for connection and fixation. After circulation was restored, the heart resumed smoothly, the anastomosis of the innominate artery was completed, and gradual rewarming was performed, ultimately leading to a smooth cessation of the surgery.

The surgery lasted approximately 4 hours, with extracorporeal circulation time of 85 minutes and stent placement time of only 5 minutes. The patient's recovery was satisfactory, and after 8 hours, he was disconnected from the ventilator with stable vital signs.

According to Professor Xie Baodong, this support system has been structurally designed so that some key steps are assisted by instruments, reducing the number of deep anastomoses compared to traditional surgery, thus lowering the operation's difficulty and helping to shorten surgical time, as well as reducing the risk of complications such as postoperative strokes, hemorrhages at anastomoses, and infections. For elderly patients or those with low surgical tolerance, this technique offers a better option for the surgical treatment of complex aortic diseases.

The successful completion of this surgery marks a new technical advance in the field of surgical treatment of complex aortic diseases at Harbin Medical University’s First Hospital, providing new technologies and treatment options for related patients.