Aortic arch replacement with prophylactic aortic arch debranching during type A acute aortic dissection repair: initial experience with 23 patients
Aortic arch replacement with prophylactic aortic arch debranching during type A acute aortic dissection repair: initial experience with 23 patients
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DOI：
10.1016/j.ejcts.2010.12.012
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发表时间：
2011-08-01
影响因子：
3.4
通讯作者：
Berti, Sergio
中科院分区：
文献类型：
--
作者：
Glauber, Mattia;Murzi, Michele;Berti, Sergio
目的：为了提高急性A型夹层修复的远期效果，我们开发了一种结合根治性手术切除的技术，同时为后续的降主动脉血管内手术创造一个安全、较长的着陆区。方法：自2006年11月以来，23例患者（62 +/- 13岁）采用特殊设计的主动脉弓移植物进行主动脉弓置换术，同时预防性主动脉上血管脱支。该技术包括替换升主动脉和主动脉弓，同时，重新定位主动脉上血管的起源，就在窦管交界处上方，为随后的支架植入创造一个长而安全的近端着陆区。灌注在冷却时通过升主动脉顺行，在复温时通过血管假体顺行。在中低温停循环25 +/- 7 min和顺行选择性脑灌注46 +/- 14 min下进行远端弓吻合。体外循环和主动脉交叉夹夹时间分别为138 +/- 46 min和63 +/- 22 min。结果：住院死亡率4.3%（1/23）。术后发病率包括5例急性肾功能衰竭和4例肺功能衰竭。未见重大神经系统并发症。在随访（22 +/- 10个月）中，生存率为100%，2例患者因动脉瘤扩大需要血管内胸主动脉修复。在这两种情况下，支架都成功地在初次修复时创建的着陆区释放。结论：我们的技术扩展了血管内治疗在A型急性夹层修复中的适用性，创造了一个长而稳定的着陆区，如果需要，无论短期还是长期，都可以安全地进行第二次血管内手术。(C) 2010欧洲心胸外科协会。Elsevier B.V.版权所有。
Objective: To improve the long-term results of acute type A dissection repair, we developed a technique that combines radical surgical resection, and, at the same time, creates a safe and long landing zone for subsequent endovascular procedure on the descending aorta. Methods: Since November 2006, 23 patients (62 +/- 13 years) underwent aortic arch replacement concomitant with prophylactic debranching of the supra-aortic vessels, with a specially designed arch graft. The technique consists of replacing the ascending aorta and the aortic arch, and, at the same time, relocating the origin of the supra-aortic vessels just above the sinotubular junction creating a long and safe proximal landing zone for subsequent stent-graft deployment. Perfusion was antegrade through the ascending aorta during cooling and through the vascular prosthesis during rewarming. Distal arch anastomosis was performed under moderate hypothermic circulatory arrest for 25 +/- 7 min and antegrade selective cerebral perfusion (46 +/- 14 min). Cardiopulmonary bypass and aortic cross-clamp time were 138 +/- 46 and 63 +/- 22 min. Results: Hospital mortality was 4.3% (1/23). Postoperative morbidity includes five acute renal failures and four lung failures. No major neurological complications were observed. At follow-up (22 +/- 10 months), survival was 100% and two patients required an endovascular thoracic aorta repair for aneurysmal enlargement. In both cases, the stent grafts were successfully released in the landing zone created at the time of primary repair. Conclusions: Our technique extends the suitability of endovascular therapies during type A acute dissection repair, creating a long and stable landing zone that allows safe performance of a second endovascular step if needed, both in the short-and long term. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.