Hybrid Approach to Management of Complex Aortic Arch Pathologies: A Single-Center Experience in China
Hybrid Approach to Management of Complex Aortic Arch Pathologies: A Single-Center Experience in China
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DOI：
10.1016/j.avsg.2015.09.019
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发表时间：
2016-02-01
影响因子：
1.5
通讯作者：
Zeng, Hesong
中科院分区：
文献类型：
--
作者：
He, Xingwei;Liu, Wanjun;Zeng, Hesong
背景：本研究的目的是总结主动脉上去分支联合胸椎血管内主动脉修复（TEVAR）混合手术治疗复杂主动脉弓疾病患者的单中心经验和中期结果。方法：回顾性分析2012 - 2015年连续43例（男37例，女6例）复杂主动脉弓病变行混合式手术的患者。43例患者中，A型主动脉夹层（AD） 12例，合并B型AD累及主动脉弓27例，主动脉弓动脉瘤2例，A型穿透性动脉粥样硬化溃疡2例。结果：患者平均年龄52.3±11.3岁。混合手术在技术上均取得成功。总的30天死亡率和住院死亡率为2.3%(1 / 43)，1例患者术后18天死于严重吸入性肺炎。30天截瘫和中风为0%。并发症包括新发肾功能不全1例和II型内漏。中位随访15个月（6-26个月）后，总死亡率为7.1% (3 / 42)，Kaplan Meier估计1年生存率为91%。只有一例晚期死亡被认为与主动脉有关。分别于6个月及以后每年行CT扫描，观察2例患者分别为lb型和II型内漏。对于lb型内漏患者，远端伸展成功。CT和超声检查均未发现晚期解剖外旁路闭塞和支架移植物移位。结论：这些初步结果表明，混合手术合并主动脉上去分支和TEVAR是复杂主动脉弓疾病患者可接受的治疗选择。短期和中期结果都是可以接受的。需要进一步大样本、长期随访的研究。
Background: The purpose of this study is to summarize a single-center experience and midterm outcomes of a combined supra-aortic debranching and thoracic endovascular aortic repair (TEVAR) for hybrid operation on patients with complex aortic arch disease.Methods: From 2012 to 2015, 43 consecutive patients (37 male and 6 females) who underwent a hybrid operation for complex aortic arch disease were retrospectively analyzed. Of the 43 patients, 12 were diagnosed with type A aortic dissection (AD), 27 with complicated type B AD involving the aortic arch, 2 with aortic arch aneurysm, and 2 with type A penetrating atherosclerosis ulcer.Results: The patients' mean age was 52.3 +/- 11.3 years. Hybrid operation was technically successful in all patients. The overall 30-day mortality and in-hospital mortality rates were 2.3% (1 of 43), with 1 patient dying at days 18 of severe aspiration pneumonia after procedure. Thirty-day paraplegia and stroke were 0%. Complication included 1 newly onset renal insufficiency and type II endoleak. After a median follow-up of 15 months (range, 6-26 months), the overall mortality was 7.1% (3 of 42), with Kaplan Meier survival estimate of 91% at 1 year. Only one late death was considered aorta-related. computed tomography (CT) scanning was performed at 6 months and annually thereafter, and 2 patients were observed with type lb endoleak and type II endoleak, respectively. For the patient with type lb endoleak, distal extension was performed successfully. No late extra-anatomic bypass occlusion and stent-graft migration were found on CT scans or ultrasound.Conclusions: These initial results suggest that hybrid operation with supra-aortic debranching, and TEVAR is an acceptable treatment option for patients with complex aortic arch disease. Short-term and midterm outcomes are acceptable. Further research with large sample size and long-term follow-up is needed.