Mori Yoshio, Hirose Hajime, Takagi Hisato, Umeda Yukio, Fukumoto Yukiomi, Shimabukuro Katsuya, Matsuno Yukihiro
First Department of Surgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan.
J Thorac Cardiovasc Surg. 2003 Aug;126(2):415-9. doi: 10.1016/s0022-5223(02)73600-3.
In acute type A dissection, replacing the ascending aorta with the transverse aortic arch recently has been recommended for event-free long-term survival. Since 1994, we have performed our new transverse aortic arch replacement, in which the distal end of the graft is anastomosed between the left common carotid artery and the left subclavian artery to reduce the risk by obtaining a good surgical view, resulting in good hemostasis. The "elephant trunk technique" was used in anticipation of a staged descending aortic operation for residual dissecting aorta. We analyzed the surgical survival of patients with Stanford type A aortic dissection undergoing our operative procedure using hypothermic selective antegrade cerebral perfusion.
We performed our new technique in 27 patients (aged 61 +/- 11 years, 15 male and 12 female patients, 22 patients with acute type A dissection, and 5 patients with chronic dissection).
One in-hospital death (3.7% in total: 4.5% in acute dissection, 0% in chronic dissection) occurred in patients undergoing our new technique. Actuarial survival (including early death) was 91% at 5 years after the operation. One late death occurred as the result of a malignant tumor. Four patients underwent a staged reoperation for aneurysmal dilatation of the residual descending aorta or renal and splenic embolism as the result of thrombus from the false lumen 2 to 11 months (mean interval 6 months) after the initial operation. They have been doing well since the reoperation.
Our "distal anastomosis to the proximal level of the distal aortic arch" technique made aortic arch replacement easier and improved the survival of the arch replacement for aortic dissection, especially for acute type A dissection, by securing hemostasis in the suture line. Combining the elephant trunk technique with our new procedure is useful to perform a staged aortic replacement for dilatation and complication of the false lumen in the descending aorta.
在急性A型主动脉夹层中，最近有人建议用横断主动脉弓置换升主动脉以实现无事件的长期生存。自1994年以来，我们开展了新的横断主动脉弓置换术，即将移植物的远端吻合于左颈总动脉和左锁骨下动脉之间，以通过获得良好的手术视野来降低风险，从而实现良好的止血效果。“象鼻技术”用于预期分期进行降主动脉手术以处理残留的夹层主动脉。我们分析了采用低温选择性顺行脑灌注进行手术的斯坦福A型主动脉夹层患者的手术生存率。
我们对27例患者（年龄61±11岁，男性15例，女性12例，急性A型夹层22例，慢性夹层5例）实施了我们的新技术。
接受我们新技术的患者中有1例院内死亡（总计3.7%：急性夹层中为4.5%，慢性夹层中为0%）。术后5年的精算生存率（包括早期死亡）为91%。1例晚期死亡是由恶性肿瘤导致。4例患者在初次手术后2至11个月（平均间隔6个月）因假腔血栓形成导致残留降主动脉瘤样扩张或肾及脾栓塞而接受分期再次手术。再次手术后他们情况良好。
我们的“在主动脉弓远端近端水平进行远端吻合”技术使主动脉弓置换更容易，并通过确保缝合线止血提高了主动脉夹层弓置换的生存率，尤其是对于急性A型夹层。将象鼻技术与我们的新手术相结合，对于降主动脉假腔扩张和并发症进行分期主动脉置换很有用。
