Novel arch fenestrated stent graft for acute Stanford Type A aortic dissection with open antegrade implantation
Novel arch fenestrated stent graft for acute Stanford Type A aortic dissection with open antegrade implantation
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DOI：
10.1093/icvts/ivx335
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发表时间：
2018-03-01
影响因子：
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通讯作者：
Wang, Dongjin
中科院分区：
文献类型：
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作者：
Zhou, Qing;Xue, Yunxing;Wang, Dongjin
结论：急性斯坦福大学A型主动脉夹层（aTAAD）累及主动脉弓的最佳手术策略仍存在争议。在此，我们报告了使用新型主动脉弓开窗型覆膜支架修复aTAAD后的满意结果。方法：从2014年12月至2015年12月，42例aTAAD患者（27例男性和15例女性）接受了升主动脉置换和开窗型覆膜支架植入术。在主动脉弓和降主动脉近端的真腔内植入开孔型覆膜支架，开孔型开口位于主动脉弓3支头血管的开口处，覆膜支架近端与涤纶管移植物远端吻合，涤纶管移植物替代升主动脉近端。所有患者在出院前和随访期间均接受了造影剂增强计算机断层扫描血管造影。平均心肺转流时间为213 ± 49分钟，主动脉阻断持续时间为133 +/- 39 min，单侧脑灌注和下体停搏持续时间为27 +/- 8 min。有2例因循环衰竭住院死亡（死亡率4.8%）。在平均7.4 ± 3.2个月的随访期内，1例白塞病患者死于主动脉根部假性动脉瘤。39名存活患者在3个月、6个月和12个月时进行了对比增强计算机断层扫描，这表明假腔血栓形成增加。结论：在aTAAD患者中，使用新型主动脉弓开窗覆膜支架实现了主动脉弓和降主动脉的良好主动脉重塑，而发病率和死亡率没有任何增加。
OBJECTIVES: The best surgical strategy for acute Stanford Type A aortic dissection (aTAAD) involving the arch remains controversial. Here, we report on the satisfactory results following aTAAD repair using a novel arch fenestrated stent graft.METHODS: From December 2014 to December 2015, 42 aTAAD patients (27 male and 15 female) underwent ascending aorta replacement and fenestrated stent graft implantation. The fenestrated stent graft was implanted into the true lumen of the aortic arch and proximal descending aorta, with the fenestration opening located at the ostia of 3 head vessels in the arch. The proximal end of the stent graft was anastomosed to the distal end of the Dacron tube graft that replaced the proximal ascending aorta. All patients underwent contrast-enhanced computed tomography angiography prior to discharge and during follow-up.RESULTS: The average cardiopulmonary bypass duration was 213 +/- 49 min, aortic cross-clamp duration was 133 +/- 39 min and unilateral cerebral perfusion and lower body arrest duration was 27 +/- 8 min. There were 2 in-hospital deaths due to circulation failure (mortality 4.8%). During a mean follow-up period of 7.4 +/- 3.2 months, 1 patient with Behcet's disease died of aortic root pseudoaneurysm. The 39 surviving patients underwent contrast-enhanced computed tomography scans at 3, 6 and 12 months, which indicated increasing false-lumen thrombosis.CONCLUSIONS: In aTAAD patients, the use of the novel arch fenestrated stent graft achieved excellent aortic remodelling of the aortic arch and descending aorta without any increase in the morbidity and mortality.