The Frozen Elephant Trunk for the Treatment of Chronic Dissection of the Thoracic Aorta: A Multicenter Experience
The Frozen Elephant Trunk for the Treatment of Chronic Dissection of the Thoracic Aorta: A Multicenter Experience
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DOI：
10.1016/j.athoracsur.2011.06.027
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发表时间：
2011-11-01
影响因子：
4.6
通讯作者：
Di Bartolomeo, Roberto
中科院分区：
文献类型：
--
作者：
Pacini, Davide;Tsagakis, Konstantinos;Di Bartolomeo, Roberto
背景由于主动脉的广泛参与，其慢性夹层的外科治疗仍然是一个外科挑战。我们进行了一项多中心经验的研究，以描述一个多中心的经验，在治疗这种复杂的病理，使用冷冻象鼻（FET）技术。在2005年1月至2010年5月期间，240例患者接受了FET技术治疗，并在国际E-vita开放登记研究中收集了他们的临床数据。90例患者（本研究的人群）接受了慢性主动脉夹层手术（A型，77%）。这90例患者的平均年龄为57 ± 12岁，其中72例（80%）为男性。62例患者（69%）既往接受过主动脉手术。所有手术均在顺行选择性脑灌注的辅助下进行。84例患者（93%）进行了主动脉弓全置换术。心脏搭桥、心肌缺血、脑灌注和内脏缺血时间分别为243 +/-65、145 +/-48、86 +/-24和75 +/-22分钟。住院死亡率为12%（11例患者）。1例患者死于卒中，8例患者（9%）死于缺血性脊髓损伤。术后及随访期间，用CT评估患者直肠内的假腔（FL）。在第一次和最后一次术后检查时，象鼻周围FL完全血栓形成率分别为69%和79%。4年生存率和无主动脉再次手术率分别为78%+/-5%和96%+/-3%。用FET技术治疗慢性主动脉夹层（AD）是可行的，具有良好的效果。使用该技术的主动脉再手术率似乎低于慢性AD修复的传统方法。缺血性脊髓损伤是FET技术的一种令人担忧的并发症，但似乎与FL血栓形成无关（Ann Thorac Surg 2011; 92：1663 - 70）（C）2011年，胸外科医师协会
Background. Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.Methods. Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 +/- 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion.Results. Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 +/- 65, 145 +/- 48, 86 +/- 24, and 75 +/- 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% +/- 5% and 96% +/- 3%, respectively.Conclusions. The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL. (Ann Thorac Surg 2011; 92: 1663-70) (C) 2011 by The Society of Thoracic Surgeons