Stanford A型急性大動脈解離に対する治療戦略

Treatment Strategy for Stanford Type A Acute Aortic Dissection

Stanford A型急性大動脈解離（A型AAD）全体での本邦における発症頻度は，人口10万人あたり3～6人と報告され，手術症例は近年増加傾向である1）．A型AADは死亡率の非常に高い疾患として知られており，診断がつき次第の緊急手術が推奨される．手術成績は近年改善傾向にあるが，依然早期死亡率は高く2，3），治療方針についても手術方法を含めてさまざまな報告があり，一定していないのが現状といえる．

The fundamental treatment of Stanford type A acute aortic dissection is a lifesaving emergency surgery in our hospital. We perform hemiarch replacement with a focus on entry tear, but an extended surgery is also performed only when resection of the entry tear is difficult. The outcomes of current therapeutic policy, along with the short-term and the long-term outcomes of different sites of entry tear, were examined retrospectively.

Three hundred and twenty surgery of Stanford type A acute aortic dissection were performed between 1991 and 2015 at our hospital. Their short-term and long-term outcomes were examined after dividing them into 7 groups according to their entry sites. We also investigated surgical methods and effects of presence/absence of residual entry tear.

As a result, overall hospital mortality was 13.1％. There was no significant difference in either short-term or long-term outcome among the groups. Likewise, no significant difference was observed in the surgical methods or the presence/absence of residual entry tear.

Recently, minimally invasive procedures, such as stent-grafting, have been applied to manage the residual entry tear. Therefore, an aggressive extended surgery is no longer inevitable and our current therapeutic policy is considered reasonable.