Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes
Hybrid approaches in the treatment of aortic arch aneurysms: Postoperative and midterm outcomes
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DOI：
10.1016/j.jtcvs.2012.11.044
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Pochettino, Alberto
中科院分区：
文献类型：
--
作者：
Bavaria, Joseph;Vallabhajosyula, Prashanth;Pochettino, Alberto
背景：开放手术和腔内联合治疗主动脉弓动脉瘤已成为一种安全的治疗方法。这个平台在治疗高龄和并存负担较大的患者方面可能会有特别重要的作用。方法：从2005年至今，685例患者接受了胸腔内修复术(TEVAR)；104例患者接受了混合弓修复术(开放+腔内途径)。在这些患者中，47名患者接受了主动脉弓瘤的治疗，其中伴有或不伴有近端升主动脉瘤。所有患者均采用胸骨正中切开入路进行弓形血管分叉，并顺行植入或不植入TEVAR支架。结果：28例患者为I型修复，8例为II型修复，11例为III型混合修复。那些有III型修复的人被排除在分析之外。弓状血管分支术后支架置入率为100%。平均年龄71±8岁。14%的病例涉及重做胸骨切开。平均体外循环时间215±分钟，阻断时间70±55分钟，停循环时间19±10分钟。截瘫发生率5.5%(n=2)，卒中发生率8%(n=3)。住院死亡率8%(n=3)。术后无一例发生内漏。平均住院时间为17.2+/-14天。中位随访期为30+/-21个月。1年、3年和5年的全因死亡率分别为71%、60%和48%。再手术率为2.7%(n=1)。在最新的随访中，没有患者发生1型或3型内漏。结论：在一组有显著并发症的老年患者中，采用混合入路治疗涉及0区支架植入的主动脉弓动脉瘤是安全的，具有良好的中期效果。这种手术可以在没有1型或3型内漏的情况下进行，可能代表着主动脉弓外科领域的一项技术进步。(《胸心外科杂志》2013；145：S85-90)
Background: The combined open surgical and endovascular approach for the treatment of aortic arch aneurysms has emerged as a safe treatment modality. This platform may have an especially important role in treating patients of old age and with a greater comorbid burden. We describe our institutional experience with the hybrid aortic arch approach, with midterm outcomes.Methods: From 2005 to the present, 685 patients have undergone thoracic endovascular repair (TEVAR); 104 had a hybrid arch repair (open plus endovascular approach). Of these, 47 patients had treatment for an aortic arch aneurysm with or without a proximal ascending aortic aneurysm. All these patients had a median sternotomy approach for arch vessel debranching and antegrade with or without retrograde TEVAR stent grafting of the arch. Results from a prospectively maintained database are reported.Results: Twenty-eight patients had type I repair, 8 patients had type II repair, and 11 patients had type III arch hybrid repair. Those with type III repair were excluded from the analysis. Stent graft deployment rate was 100% after arch vessel debranching. Mean age was 71 +/- 8 years. Fourteen percent of cases involved a redo sternotomy. Average cardiopulmonary bypass time was 215 +/- 64 minutes, with a crossclamp time of 70 +/- 55 minutes and a circulatory arrest time of 19 +/- 10 minutes. The paraplegia rate was 5.5% (n = 2), with a stroke rate of 8% (n = 3). In-hospital mortality was 8% (n = 3). There were no postoperative endoleaks. The mean length of stay was 17.2 +/- 14 days. The median follow-up was 30 +/- 21 months. Freedom from all-cause mortality was 71%, 60%, and 48% at 1, 3, and 5 years, respectively. The aortic reoperation rate was 2.7% (n = 1). No patient has a type 1 or 3 endoleak at latest follow-up.Conclusions: The hybrid approach to aortic arch aneurysm involving a zone 0 stent graft landing can be safely adopted with good midterm results in a cohort of old patients with significant comorbidity. This procedure can be performed with no type 1 or 3 endoleaks and may represent a technical advancement in the field of aortic arch surgery. (J Thorac Cardiovasc Surg 2013;145:S85-90)