Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection
Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection
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DOI：
10.1016/j.athoracsur.2010.07.077
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Esposito, Giampiero
中科院分区：
文献类型：
--
作者：
Marullo, Antonino G. M.;Bichi, Samuele;Esposito, Giampiero
背景。我们评估了DeBakey I型主动脉夹层混合入路的中期结果，使用一种新的多支涤纶移植物，通过将弓血管的流入开口向主动脉根部重新定位，形成一个新的主动脉弓，从而更容易、更安全地在胸主动脉远端进行第二阶段血管内支架移植。从2006年3月到2008年7月，24例DeBakey I型主动脉夹层患者接受了升主动脉和主动脉弓置换术，并使用一种新的假体去分支主动脉，为随后可能的远段胸主动脉血管内支架植入术创造一个最佳的着陆点。15例术后出现远端假腔残余未闭的患者成功进行了二期血管内支架植入。手术期1例死亡，血管内期无一例死亡，住院死亡率为4.2%。随访证实95.6%的患者残留远端假腔完全血栓形成，4.4%的患者部分血栓形成，在需要血管内手术的病例中没有内漏的证据。28个月的总精算生存率为92.1% +/- 7.9%，100%免于再手术。证实使用一种新的多分支假体（Lupiae Graft; Vascutek Terumo Inc, Scotland, United Kingdom）混合治疗DeBakey I型主动脉夹层并主动脉弓去分支，以促进随后的血管内完成。中期结果在生存和远端假腔血栓方面是令人满意的。有必要对这一行动进行进一步研究，以确认这一方法的有效性和持久性。
Background. We assess midterm results of a hybrid approach to DeBakey type I aortic dissection using a new multibranched Dacron graft to create, by relocation of the inflow openings to the arch vessels toward the aortic root, a new aortic arch for an easier and safer second-staged endovascular stent grafting of the distal thoracic aorta.Methods. From March 2006 to July 2008 24 patients with DeBakey type I aortic dissection underwent ascending aorta and aortic arch replacement with debranching of epiaortic vessels using a new prosthesis to create an optimal landing zone for possible subsequent endovascular stent grafting of the distal thoracic aorta. Fifteen patients, who postoperatively presented a residual patent distal false lumen, underwent a successful second-stage endovascular stent-graft implantation.Results. One patient died after the surgical stage while there was no death after the endovascular stage with hospital mortality of 4.2%. Follow-up confirmed complete thrombosis of the residual distal false lumen in 95.6% and partial thrombosis in 4.4% of patients with no evidence of endoleaks in the cases that required the endovascular procedure. Overall actuarial survival at 28 months is 92.1% +/- 7.9% with 100% freedom from reoperation.Conclusions. Hybrid treatment of DeBakey type I aortic dissection with aortic arch debranching, using a new multibranched prosthesis (Lupiae Graft; Vascutek Terumo Inc, Scotland, United Kingdom) is confirmed to facilitate the subsequent endovascular completion. Midterm results in terms of survival and distal false lumen thrombosis are satisfactory. Further study of this operation is warranted to confirm the effectiveness and the durability of this approach.