Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair
Outcomes of Endovascular Repair of Ascending Aortic Dissection in Patients Unsuitable for Direct Surgical Repair
复制标题
不适合直接手术修复的升主动脉夹层血管内修复的结果
DOI：
10.1016/j.jacc.2016.08.031
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发表时间：
2016-11-01
影响因子：
24
通讯作者：
Jing, Zaiping
中科院分区：
文献类型：
--
作者：
Li, Zhenjiang;Lu, Qingsheng;Jing, Zaiping
背景：对于无法接受升主动脉夹层紧急手术修复的患者，支架植入术是一种治疗选择。然而，关于结果的随访是有限的。目的：本研究报告了血管内修复术治疗升主动脉夹层的中期结果。方法2009年5月1日至2011年1月31日，15例不适合直接手术修复的升主动脉夹层患者（年龄45 ~ 78岁）行血管内修复术（1例急性夹层，7例亚急性夹层，7例慢性夹层），随访时间中位为72个月（61 ~ 81个月）。结果主动脉夹层发病至治疗的平均间隔时间为25.5天（6 ~ 353天）。所有患者均取得了技术上的成功。围手术期无重大发病或死亡。随访期间无死亡病例，发生并发症8例，再干预4例。在主动脉弓新的夹层治疗分支内移植物。一名患者发生逆行主动脉夹层，左心室假性动脉瘤通过开放手术成功治疗。1例心血管缺血接受支架治疗，1例室上性心动过速接受射频消融术治疗。其他并发症包括：移植物周围腔内漏、鸟喙征、暂时性心包积液和左肾萎缩。12个月时观察到真腔明显增大，假腔和整个胸主动脉明显缩小。随后没有发现明显的变化。随着时间的推移，对主动脉瓣功能的影响最小。结论：新型血管内手术的结果是可以接受的。需要更多的证据和样本量更大、随访时间更长的研究来支持这种新技术的持久性。(C) 2016年由美国心脏病学会基金会发布。
BACKGROUND Stent grafting is a therapeutic option for patients who are unable to undergo urgent surgical repair of ascending aortic dissections. However, follow-up regarding outcomes is limited.OBJECTIVES This study reports mid-term outcomes with endovascular repair for ascending aortic dissections in patients deemed high risk for open repair. METHODS Between May 1, 2009 and January 31, 2011, 15 ascending aortic dissection patients (ages 45 to 78 years) ineligible for direct surgical repair underwent endovascular repair (1 acute dissection, 7 subacute dissections, and 7 chronic dissections) and were closely followed up for a median of 72 months (range 61 to 81 months).RESULTS The mean interval between aortic dissection onset and treatment was 25.5 (range 6 to 353) days. Technical success was achieved in all patients. No major morbidity or deaths occurred perioperatively. During the follow-up period, there were no deaths, 8 complications occurred, and there were 4 reinterventions. A new dissection in the aortic arch was treated with a branched endograft. One patient developed retrograde aortic dissection and a left ventricular pseudoaneurysm was successfully treated with open surgery. One cardiovascular ischemia was treated with stenting and 1 supraventricular tachycardia was treated with radiofrequency ablation. Other morbidities included perigraft endoleak, a bird-beak sign, a temporary pericardial effusion, and a left kidney atrophy. Significant enlargements of true lumens and shrinkage of false lumens and overall thoracic aorta were observed at 12 months. No significant changes were detected subsequently. Minimal impact on aortic valve function was recorded over time.CONCLUSIONS Our results with the novel endovascular procedure appear acceptable. Additional evidence and studies with larger sample size and longer follow-up are needed to support the durability of this new technique. (C) 2016 by the American College of Cardiology Foundation.