Outcomes of emergency in situ laser fenestration-assisted thoracic endovascular aortic repair in patients with acute Stanford type A aortic dissection unfit for open surgery
Outcomes of emergency in situ laser fenestration-assisted thoracic endovascular aortic repair in patients with acute Stanford type A aortic dissection unfit for open surgery
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紧急原位激光开窗辅助胸主动脉腔内修复术治疗不适合开放手术的急性斯坦福A型主动脉夹层患者的结果
DOI：
10.1016/j.jvs.2019.08.233
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发表时间：
2020-05-01
影响因子：
4.3
通讯作者：
Lu, Xinwu
中科院分区：
文献类型：
--
作者：
Yan, Dong;Shi, Huihua;Lu, Xinwu
目的：探讨急诊原位激光开窗(ISLF)辅助胸主动脉腔内修复术(TEVAR)治疗不宜开放手术的急性Stanford A型主动脉夹层患者的疗效。方法：自2016年3月至2018年12月，对20例不宜开放手术的急性Stanford A型主动脉夹层患者行紧急原位激光开窗胸腔内修复术。血管内修复的解剖学标准：不累及冠状动脉和主动脉瓣，近端着陆区直径小于或等于45 mm，近端着陆区长度大于或等于20 mm。结果：20例患者手术成功率为100.0%。术后30d病死率为10%；术后死亡2例，1例死于重症肺炎，1例死于脑出血。30d时卒中发生率为5%。平均随访16个月(3~26个月)。1例于术后23个月死于心力衰竭。Kaplan-Meier曲线分析显示24个月生存率为77.1%。两名患者有Ia型内漏，一名患者有II型内漏。无支架移植物迁移或与开窗相关的内漏，所有患者在支架移植物被覆盖的部分有血栓形成的假腔。随访期内无再介入、心肌梗死、短暂性脑缺血发作、脑梗塞等并发症发生。结论：急诊经皮冠状动脉腔内成形术是治疗不宜开放手术的急性Stanford A型主动脉夹层的一种安全有效的替代方法。
Objective: This study investigated the outcomes of emergency in situ laser fenestration (ISLF)-assisted thoracic endovascular aortic repair (TEVAR) for patients with acute Stanford type A aortic dissection unfit for open surgery.Methods: Twenty patients with acute Stanford type A aortic dissection who were found to be unfit for open surgery, underwent emergency ISLF-assisted TEVAR in our center between March 2016 and December 2018. Anatomic criteria for endovascular repair: coronary artery and aortic valve was not involved, proximal landing zone diameter of 45 mm or less, and proximal landing zone length of 20 mm or greater. Their clinical outcomes were reviewed retrospectively.Results: Twenty patients achieved a procedural success of 100.0%. The 30-day mortality was 10%; two patients died, one of severe pneumonia and the other from cerebral hemorrhage after the operation. Rate of stroke at 30 days was 5%. The average follow-up time was 16 months (range, 3-26 months). One death owing to heart failure occurred at 23 months postoperatively. Kaplan-Meier curve analysis revealed that the 24-month survival rate was 77.1%. Two patients had type Ia endoleaks and one had a type II endoleak. There was no stent graft migration or fenestration-related endoleak and all patients had a thrombosed false lumen in the covered section of the stent grafts. No reintervention, myocardial infarction, transient ischemic attacks, cerebral infarction, or other complications occurred during the follow-up period.Conclusions: Emergency ISLF-assisted TEVAR is a safe and effective alternative method for treating acute Stanford type A aortic dissection unfit for open surgery.