Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre studyaEuro
Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre studyaEuro
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DOI：
10.1093/ejcts/ezv150
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发表时间：
2016-02-01
影响因子：
3.4
通讯作者：
Jakob, Heinz
中科院分区：
文献类型：
--
作者：
Leontyev, Sergey;Tsagakis, Konstantinos;Jakob, Heinz
涉及主动脉弓和降主动脉的广泛性胸主动脉疾病患者的治疗通常使用冷冻象鼻（FET）技术进行。我们使用前瞻性数据库回顾性分析了该技术的早期结局。在2005年1月至2014年1月期间，在多中心数据库中登记了509例FET手术后患者（平均年龄：61 ± 11岁）。350例（68.8%）患者的手术适应症为急性或慢性主动脉夹层（AD），159例（31.2%）患者为退行性或动脉粥样硬化性动脉瘤（DA）。建立Logistic回归模型，以确定住院死亡率和神经系统并发症的独立预测因素，平均住院死亡率为15.9%（n = 81），其中AD患者为17.1%，DA患者为13.2%（P = 0.2）。院内死亡率的独立预测因素为血流动力学不稳定[比值比（OR）：2.7，P = 0.005]、外周血管疾病（OR：2.6，P = 0.002）、糖尿病（OR：2.1，P = 0.05）和选择性脑灌注时间> 60 min（OR：2.2，P = 0.005）。60岁以下患者和FET植入期间使用导丝可保护早期生存。7.7%（n = 39）的患者发生卒中。7.5%（n = 38）的患者发生截瘫或轻瘫。T10以下是脊髓损伤的独立预测因素（OR：2.3，P = 0.03），应考虑更快的弓置换技术和控制FET放置，以减少FET术后早期死亡率和神经系统并发症。对于远端主动脉病变，建议采用两阶段方法，而不是FET着陆低于T10。
The treatment of patients with extensive thoracic aortic disease involving the arch and descending aorta is often performed, using the frozen elephant trunk (FET) technique. We retrospectively analysed early outcomes with this technique, using a prospective database.A total of 509 patients (mean age: 61 +/- 11 years) were registered between January 2005 and January 2014 in a multicentre database after FET surgery. Acute or chronic aortic dissection (AD) was the indication for surgery in 350 (68.8%) patients and degenerative or atherosclerotic aneurysm (DA) accounted for 159 (31.2%) patients. A logistic regression model was created to identify independent predictors of in-hospital mortality and neurological complications.The average in-hospital mortality was 15.9% (n = 81) with 17.1% for AD patients and 13.2% for DA patients (P = 0.2). Independent predictors of in-hospital mortality were haemodynamic instability [odds ratio (OR): 2.7, P = 0.005], peripheral vascular disease (OR: 2.6, P = 0.002), diabetes (OR: 2.1, P = 0.05) and selective cerebral perfusion time > 60 min (OR: 2.2, P = 0.005). Patients under 60 years of age and the use of guide wire during FET implantation were protective for early survival. Stroke occurred in 7.7% (n = 39) of patients. Paraplegia or paraparesis occurred in 7.5% (n = 38) of patients. A distal landing zone lower than T10 was an independent predictor for spinal cord injury (OR: 2.3, P = 0.03).Techniques for faster arch replacement and controlled FET placement should be considered in order to reduce the early mortality and neurological complications after FET surgery. For distal aortic lesions, a two-staged approach is suggested, rather than the FET landing lower than T10.