Total Arch Replacement Combined With Stented Elephant Trunk Implantation A New "Standard" Therapy for Type A Dissection Involving Repair of the Aortic Arch?
Total Arch Replacement Combined With Stented Elephant Trunk Implantation A New "Standard" Therapy for Type A Dissection Involving Repair of the Aortic Arch?
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DOI：
10.1161/circulationaha.110.015081
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发表时间：
2011-03-08
期刊：
影响因子：
37.8
通讯作者：
Zheng, Jun
中科院分区：
文献类型：
--
作者：
Sun, LiZhong;Qi, RuiDong;Zheng, Jun
背景-A型夹层的适当外科处理是获得满意结果的关键因素，但最佳手术方式的选择存在争议。方法与结果：从2003年1月至2008年9月，排除14例次全或全主动脉置换，411例A型夹层(有支架象鼻=291例，传统手术修复=120例)接受了主动脉弓置换。住院病死率：支架组为3.09%(9/291)，急性组为4.73%(7/148)，慢性组为1.40%(2/143)，常规组为5.00%(6/120)，急性组为6.06%(4/66)，慢性组为3.70%(2/54)。脊髓损伤支架置入组为2.41%(7/291)，常规组为0.83%(1/120)。卒中总患病率为1.95%(8/411)(支架植入=2.41%，7/291；常规=0.83，1/120)。急性夹层(支架植入1例，常规4例；P=0.031)和慢性夹层(支架4例，常规2例，P=0.661)二次介入治疗的发生率为3.05%。94.2%(130/138)的急性夹层患者和92.0%(126/137)的慢性夹层患者假腔消失。结论：全弓置换联合带支架象鼻植入术显示了手术和介入相结合的优势，同时避免了单独方法的缺点。令人鼓舞的手术结果可能使这一手术成为A型夹层的新的“标准”疗法，包括修复主动脉弓。(发行量。2011年；123：971-978。)
Background-Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch.Methods and Results-Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 patients with type A dissection (stented elephant trunk = 291, conventional surgical repair = 120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acute = 4.73%, 7 of 148; chronic = 1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acute = 6.06%, 4 of 66; chronic = 3.70%, 2 of 54). Spinal cord injury was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of stroke was 1.95% (8 of 411) (stented = 2.41%, 7 of 291; conventional = 0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stented = 1 and conventional = 4; P = 0.031) and 3.05% (6 of 197) for chronic dissection (stented = 4 and conventional = 2; P = 0.661) during follow-up. Obliteration of the false lumen around the stented elephant trunk occurred in 94.2% (130 of 138) of patients with acute dissection and in 92.0% (126 of 137) of patients with chronic dissection.Conclusions-Total arch replacement combined with stented elephant trunk implantation demonstrated the superiority of the combination of the surgical and interventional approaches while avoiding the weaknesses associated with the individual methods. The encouraging surgical results could enable this procedure to become the new "standard" therapy for type A dissection involving repair of the aortic arch. (Circulation. 2011; 123: 971-978.)