Early- and mid-term aortic remodelling after the frozen elephant trunk technique for retrograde type A acute aortic dissection using the new Japanese J Graft open stent graft
Early- and mid-term aortic remodelling after the frozen elephant trunk technique for retrograde type A acute aortic dissection using the new Japanese J Graft open stent graft
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DOI：
10.1093/icvts/ivx144
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发表时间：
2017-11-01
影响因子：
--
通讯作者：
Yamada, Kazunori
中科院分区：
文献类型：
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作者：
Yamane, Yoshitaka;Uchida, Naomichi;Yamada, Kazunori
目的：我们先前曾施行冷冻象鼻（FET）技术治疗急性A型主动脉夹层，试图改善长期预后。在这项研究中，我们报告了FET技术治疗逆行A型急性主动脉夹层的中期结果，使用一种新器械，J Graft开放式覆膜支架（JOSG）。（平均年龄：59.3 +/- 13.9岁）采用FET技术使用JOSG进行全主动脉弓置换术治疗逆行A型急性主动脉夹层。结果：JOSG平均外径25-35 mm，平均28 ± 2.8 mm。JOSG远端边缘的平均位置为Th 6.6 +/- 1.1。1年累计生存率为91.6%。术后1年的术后计算机断层扫描显示，所有患者的覆膜支架远端边缘和主动脉瓣水平均存在完全血栓形成。在主动脉水平，14例（70%）患者出现完全血栓形成，大多数患者（90%）在上级肠系膜动脉水平的假腔通畅。结论：使用FET技术与JOSG逆行A型急性主动脉夹层提供了良好的结果。通过正确使用JOSG，可以扩张真腔并消除前向性假腔血流，从而实现良好的主动脉重塑。此外，从覆膜支架到主动脉瓣的假腔应该闭塞，这可能会减少长期并发症。
OBJECTIVES: We previously performed the frozen elephant trunk (FET) technique for acute type A aortic dissection to try to improve the long-term prognosis. In this study, we report the mid-term results of the FET technique for treating retrograde type A acute aortic dissection using a new device, the J Graft open stent graft (JOSG).METHODS: Between January 2008 and December 2015, 24 patients (mean age: 59.3 +/- 13.9 years) underwent total arch replacement with the FET technique using the JOSG for retrograde type A acute aortic dissection. All patients had at least 1 year of follow-up imaging.RESULTS: The average outer diameter of the JOSG was 28 +/- 2.8mm (range: 25-35 mm). The average position of the distal edge of the JOSG was Th 6.6 +/- 1.1. The cumulative survival rate at 1 year was 91.6%. Postoperative computed tomography 1 year after surgery showed that complete thrombosis was present in all patients at the level of the distal edge of the stent graft and the aortic valve. At the diaphragmatic level, complete thrombosis was seen in 14 (70%) patients, the false lumen was patent in most patients (90%) at the superior mesenteric artery level.CONCLUSIONS: The use of the FET technique with the JOSG for retrograde type A acute aortic dissection provides good outcomes. With the proper use of the JOSG, it is possible to expand the true lumen and eliminate antegrade false-lumen flow, resulting in good aortic remodelling. Furthermore, there should be obliteration of the false lumen from the stent graft to the aortic valve, and this might reduce long-term complications.