The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience
The frozen elephant trunk technique for acute type A aortic dissection: results from 15 years of experience
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DOI：
10.1093/ejcts/ezu173
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发表时间：
2015-02-01
影响因子：
3.4
通讯作者：
Sueda, Taijiro
中科院分区：
文献类型：
--
作者：
Katayama, Akira;Uchida, Naomichi;Sueda, Taijiro
目标：我们的目的是评估使用冷冻象鼻（FET）技术预防性修复降主动脉治疗急性A型主动脉夹层（AAAD）的长期预后。（平均年龄：64.4 ± 10.9岁）因AAAD接受FET全弓置换术; 36例患者的入口位于降主动脉，68例患者的年龄< 70岁，8例患者患有马凡氏综合征。关于术前发病率，23例患者发生卒中，10例发生冠状动脉缺血，9例发生内脏缺血。在术中测量，所需的尺寸和长度的覆膜支架被确定和经食管超声引导下插入。结果：7例（6%）在医院死亡。发现4例（3%）卒中和2例（2%）脊髓损伤。出院前的计算机断层扫描显示113例患者的覆膜支架假腔完全血栓形成，出院前平均直径为26.0 +/- 2.5 mm，术后1年为27.5 +/- 2.5 mm，而覆膜支架平均直径为27.8 +/- 1.7 mm。（平均周期：104.6 +/- 51.9个月），12例患者死于非主动脉事件，5例需要使用降主动脉血管内支架植入术进行远端主动脉再次手术，包括1例新撕裂形成。在最终随访时，所有患者的覆膜支架上均未出现通畅的假腔。10年生存率为75%，胸主动脉10年无再手术率为93%。结论：FET技术可使下游主动脉重建良好，可改善AAAD的长期预后。
OBJECTIVES: We aimed to evaluate the long-term prognosis of prophylactic repair of the descending aorta using the frozen elephant trunk (FET) technique for acute type A aortic dissection (AAAD).METHODS: Between 1997 and 2012, 120 consecutive patients (mean age: 64.4 +/- 10.9 years) underwent total arch replacement with FET for AAAD; 36 patients had an entry at the descending aorta, 68 patients were aged < 70 years and 8 patients had Marfan's syndrome. With regard to preoperative morbidity, 23 patients had stroke, 10 had coronary ischaemia and 9 had visceral ischaemia. During intraoperative measurement, the required size and length of the stent graft were determined and inserted under transoesophageal echographic guidance.RESULTS: Seven patients (6%) died in the hospital. Four (3%) cases of stroke and 2 (2%) with spinal cord injuries were noted. Computed tomography prior to discharge indicated complete thrombosis of the false lumen by the stent graft in 113 patients, with a mean diameter of 26.0 +/- 2.5 mm before discharge and 27.5 +/- 2.5 mm at 1 year postoperatively compared with a mean stent graft diameter of 27.8 +/- 1.7 mm. During the long-term follow-up (mean period: 104.6 +/- 51.9 months), 12 patients died of non-aortic events and 5 distal aortic reoperations were required using endovascular stent grafting of the descending aorta, including 1 case with new tear formation. None of the patients had a patent false lumen on the stent graft at the final follow-up. The 10-year survival rate was 75% and the overall 10-year reoperation-free rate on the thoracic aorta was 93%.CONCLUSIONS: The FET technique results in excellent aortic remodelling of the downstream aorta and can improve the long-term outcomes for AAAD.