Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS)
Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS)
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DOI：
10.1093/ejcts/ezy313
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发表时间：
2019-01-01
影响因子：
3.4
通讯作者：
Wyss, Thomas R.
中科院分区：
文献类型：
--
作者：
Czerny, Martin;Schmidli, Jurg;Wyss, Thomas R.
1.1目的近十年来，胸主动脉病变累及主动脉弓患者的治疗选择大大拓宽。传统上，主动脉弓病理的治疗是心脏直视手术的一个领域。血管和血管内联合手术的出现开辟了一个新的领域，从而使以前手术和不太适合的患者的治疗成为可能。随着随后的技术飞跃，支弓支架移植成为可能，目前在社区中获得认可。此外，开放手术也有了很大的改进，在体温较低的下体循环停止时间增加使用右锁骨下动脉插管和选择性顺行脑灌注（SACP），以及改进的器官功能监测，在这些仍然重要的手术中取得了良好的效果。尽管如此，神经系统并发症仍然是所有治疗主动脉弓病理的手术的主要关注点，无论是开放手术还是血管内修复。将神经系统并发症减少到最低限度将是未来的主要任务之一。
1.1 PurposeThe last decade has substantially broadened treatment options for patients with thoracic aortic pathology involving the aortic arch. Traditionally, treatment of aortic arch pathology was a domain of open cardiac surgery. The advent of combined vascular and endovascular procedures opened a new field thereby enabling treatment in previously operated on and in less fit patients. As a subsequent technological leap, branched arch stent grafts became available and are currently gaining acceptance in the community. Also, open surgery has substantially improved, and the increased use of right subclavian artery cannulation and selective antegrade cerebral perfusion (SACP) at warmer lower body circulatory arrest times together with improved monitoring of organ function has substantially contributed to excellent results in these still major operations. Still, neurological complications remain a major concern of all procedures addressing aortic arch pathology irrespective if open surgery or endovascular repair. The reduction of neurological complications to a minimum will be one of the major tasks of the future.