Long-term results of the open stent-grafting technique for extended aortic arch disease
Long-term results of the open stent-grafting technique for extended aortic arch disease
复制标题
DOI：
10.1016/j.jtcvs.2007.10.056
复制
发表时间：
2008-06-01
影响因子：
6
通讯作者：
Sawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Shimamura, Kazuo;Kuratani, Toru;Sawa, Yoshiki
目的：本报告阐明了我们12年经验中采用开放式支架移植技术行扩大主动脉弓置换术的长期安全性和有效性。方法：从1994年到2004年，126例患者（平均年龄67.8岁），主动脉弓延伸至降主动脉的病理状况不同（57例夹层[急性/慢性= 31/26]和69例动脉瘤）采用开放式覆膜支架技术进行了手术。在深低温停循环与选择性脑灌注期间，通过横断的近端主动脉弓输送覆膜支架，并用4分支假体进行主动脉弓置换术。围手术期发病率包括7例（5.6%）卒中和8例（6.3%）脊柱损伤（3例截瘫，5例一过性下肢轻瘫）。63%的患者在24小时内拔管。在长期随访中（平均60.4 ± 36.5个月，最长153个月），1年、5年和8年的生存率分别为81.1%、63.3%和53.7%。观察到5例（3.9%）晚期内漏，但通过成功的额外腔内修复术进行了治疗。术后1、5、8年无内漏率分别为98.0%、91.1%、91.1%.Conclusion：长期观察显示开放式覆膜支架技术治疗主动脉弓疾病的安全性和良好的耐久性。对于主动脉弓动脉瘤远端延伸和需要主动脉弓置换术的主动脉弓夹层，该技术可能是一种有吸引力的治疗选择。
Objective: This report elucidates the long-term safety and effectiveness of extended aortic arch replacement with an open stent-grafting technique from our 12 years of experience.Methods: From 1994 to 2004, 126 patients (mean age 67.8 years) with different pathologic conditions of the aortic arch with extension to the descending aorta (57 dissections [acute/chronic = 31/26] and 69 aneurysms) were operated on with an open stent-grafting technique. During deep hypothermic circulatory arrest with selective cerebral perfusion, the stent graft was delivered through the transected proximal aortic arch, and arch replacement with a 4-branched prosthesis was performed.Results: Operative mortality within 30 days was 3.2%. Perioperative morbidity included 7 (5.6%) strokes and 8 (6.3%) spinal injuries (paraplegia in 3, transient paraparesis in 5). Sixty-three percent of the patients were extubated within 24 hours. In long-term follow-up (mean 60.4 +/- 36.5 months, maximum 153 months), survival was 81.1%, 63.3%, and 53.7% at 1, 5, and 8 years. Five (3.9%) late endoleaks were observed but treated with successful additional endovascular repair. Freedom from endoleaks was 98.0%, 91.1%, and 91.1% for 1, 5, and 8 years, respectively.Conclusion: Long-term observation showed safety and good durability of the open stent-grafting technique for aortic arch disease. This technique could be an attractive treatment option for aortic arch aneurysm with distal extension and aortic dissection requiring aortic arch replacement.