Single-stage hybrid total arch replacement for extended arch aneurysms
Single-stage hybrid total arch replacement for extended arch aneurysms
复制标题
DOI：
10.1016/j.jvs.2018.08.184
复制
发表时间：
2019-06-01
影响因子：
4.3
通讯作者：
Shiose, Akira
中科院分区：
文献类型：
--
作者：
Oishi, Yasuhisa;Sonoda, Hiromichi;Shiose, Akira
目的：扩展主动脉弓动脉瘤的治疗策略仍然存在争议，并且自引入胸主动脉腔内修复术以来发生了重大变化。我们采用一期混合（s-hybrid）全弓置换术（TAR），包括升主动脉置换和弓状血管脱支，与胸主动脉腔内修复术连续治疗扩展的弓状动脉瘤。本研究的目的是调查的短期结果的s-混合TAR，并澄清这种方法的好处：我们回顾了62例患者的手术结果进行了选择性s-混合TAR或传统的TAR（c-TAR）通过中位数的方法，从2008年至2017年。我们在15例患者中使用了s-混合入路，在47例患者中使用了c-TAR入路。两组均采用腋动脉灌注和亚低温下选择性顺行脑灌注进行脑保护。我们比较了两组的围手术期结局。结果：我们在所有15例扩展动脉瘤患者中完成了S-混合TAR。与c-TAR组相比，s-hybrid组需要更短的心肌缺血、选择性顺行脑灌注和下半身循环停搏时间。s-混合组并发喉返神经麻痹和通气支持时间长的患者较少。无患者发生严重内漏或永久性截瘫。院内死亡率为6.7%，在s-混合组和0%，在c-TAR group.Conclusions：s-混合TAR有相同或更好的围手术期结果相比，c-TAR的方法。对于扩展的动脉瘤，该技术可以解决左胸切口引起的呼吸衰竭问题，也可以解决分期手术等待期间的破裂问题。
Objective: The therapeutic strategy for extended aortic arch aneurysms remains controversial and has changed substantially since thoracic endovascular aortic repair was introduced. We applied single-stage hybrid (s-hybrid) total arch replacement (TAR), which involved ascending aorta replacement and debranching of arch vessels, consecutively performed with thoracic endovascular aortic repair for extended arch aneurysms. The aim of this study was to investigate the short-term results of s-hybrid TAR and to clarify the benefit of this method.Methods: We reviewed the operative results of 62 patients who underwent elective s-hybrid TAR or conventional TAR (c-TAR) through the median approach from 2008 to 2017. We used the s-hybrid approach in 15 patients and the c-TAR approach in 47 patients. In both groups, axillary arterial perfusion and selective antegrade cerebral perfusion under moderate hypothermia were applied for brain protection. We compared the perioperative outcomes of the two groups.Results: We completed s-hybrid TAR in all 15 patients with extended aneurysms. The s-hybrid group required shorter times for myocardial ischemia, selective antegrade cerebral perfusion, and circulatory arrest of the lower body compared with the c-TAR group. The patients with complicated recurrent laryngeal nerve palsy and long ventilation support times were fewer in the s-hybrid group. No patient had substantial endoleaks or permanent paraplegia. The in-hospital mortality rates were 6.7% in the s-hybrid group and 0% in the c-TAR group.Conclusions: The s-hybrid TAR has the same or better perioperative outcomes compared with the c-TAR approach. For extended aneurysms, this technique could resolve the problem of respiratory failure induced by left thoracotomy and also resolve the problem of rupture during the waiting period in staged surgery.