Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection
Early and mid-term outcomes of total arch replacement with the frozen elephant trunk technique for type A acute aortic dissection
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DOI：
10.1093/icvts/ivz154
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发表时间：
2019-11-01
影响因子：
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通讯作者：
Kamohara, Keiji
中科院分区：
文献类型：
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作者：
Furutachi, Akira;Takamatsu, Masanori;Kamohara, Keiji
目的：本研究的目的是评估冷冻象鼻（FET）技术的结果，使用J Graft FROZENIX治疗斯坦福大学A型急性主动脉夹层，与未冷冻象鼻技术进行比较。方法：2010年1月至2018年8月，我们在我院为斯坦福大学A型急性主动脉夹层进行了全弓置换术。30例患者接受象鼻手术（ET组），20例患者接受FET手术（FET组）。为了评估主动脉重塑，我们测量了主动脉，真腔和假腔的面积在12个月的follow.RESULTS：术前特征和手术时间没有显着差异，两组之间。ET组输血量明显多于FET组。ET组中73.3%（22/30例患者）的最近端入口撕裂切除或闭合，FET组中100%（20/20例患者）（P=0.015）。FET组无一例出现返神经麻痹或截瘫。FET组中有3例（15.8%）发生覆膜支架诱导的新进入。两组在主动脉面积、真腔面积和假腔面积方面无显著差异。结论：在斯坦福大学A型急性主动脉夹层中采用FET技术行全弓置换术存在明显的并发症风险;然而，通过全面的提前计划，应该可以安全地实施这种治疗。需要进一步随机化，并对每种技术进行比较，以提供FET是否适用于急性斯坦福大学A型主动脉夹层的明确结论。
OBJECTIVES: The aim of this study was to evaluate the outcomes of the frozen elephant trunk (FET) technique, using the J Graft FROZENIX for Stanford type A acute aortic dissection, in comparison with the unfrozen elephant trunk technique.METHODS: Between January 2010 and August 2018, we performed total arch replacement for Stanford type A acute aortic dissection in our hospital. Thirty patients were treated by the elephant trunk procedure (ET group), and 20 patients were treated by the FET procedure (FET group). To evaluate aortic remodelling, we measured the area of the aorta, the true lumen and the false lumen at 12months of follow-up.RESULTS: Preoperative characteristics and operation time were not significantly different between the 2 groups. The quantity of blood transfused was much greater in the ET group than in the FET group. Resection or closure of the most proximal entry tear was obtained in 73.3% (22 out of 30 patients) in the ET group and 100% (20 out of 20 patients) in the FET group (P=0.015). There was no case that had recurrent nerve palsy or paraplegia in the FET group. Stent graft-induced new entry occurred in 3 cases (15.8%) in the FET group. There were no significant differences between the 2 groups in aortic area, true lumen area or false lumen area.CONCLUSIONS: Total arch replacement with the FET technique in Stanford type A acute aortic dissection carries a risk of distinct complications; however, with thorough advance planning, it should be possible to safely institute this treatment. Further randomization, with a comparison of each technique, is required to provide clear conclusions whether the FET is useful for acute Stanford type A aortic dissection.