LeMaire Scott A, Carter Stacey A, Coselli Joseph S
Texas Heart Institute, St. Luke's Episcopal Hospital, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.
Ann Thorac Surg. 2006 May;81(5):1561-9; discussion 1569. doi: 10.1016/j.athoracsur.2005.11.038.
Extensive thoracic aortic aneurysms that involve the ascending, arch, and descending segments require challenging repairs associated with substantial morbidity and mortality. The purpose of this report is to evaluate contemporary outcomes after surgical repair of extensive thoracic aortic aneurysms using a two-stage approach with the elephant trunk technique.
During a 15 1/2-year period, 148 consecutive patients underwent total aortic arch replacement using the elephant trunk technique. Seventy-six of these patients (51%, 76/148) returned for second-stage repair of the descending thoracic or thoracoabdominal aorta 4.9 +/- 7.5 months after the first stage.
Operative mortality after the proximal aortic stage was 12% (18/148). Seven patients (5%) had strokes. Among the patients who subsequently underwent distal aortic repair, operative mortality was 4% (3/76). Two patients (3%) developed paraplegia. Long-term survival after completing the second stage of repair was 70 +/- 6% at 5 years and 59 +/- 7% at 8 years.
Contemporary management of extensive thoracic aortic aneurysms using the two-stage elephant trunk technique yields acceptable short-term and long-term outcomes. This technique remains an important component of the surgical armamentarium.
累及升主动脉、主动脉弓和降主动脉节段的广泛性胸主动脉瘤修复手术具有挑战性，且伴有较高的发病率和死亡率。本报告旨在评估采用象鼻技术分两阶段手术修复广泛性胸主动脉瘤后的当代治疗效果。
在15年半的时间里，148例连续患者采用象鼻技术进行了全主动脉弓置换术。其中76例患者（51%，76/148）在第一阶段手术后4.9±7.5个月返回接受降主动脉或胸腹主动脉的第二阶段修复。
近端主动脉手术阶段的手术死亡率为12%（18/148）。7例患者（5%）发生中风。在随后接受远端主动脉修复的患者中，手术死亡率为4%（3/76）。2例患者（3%）发生截瘫。完成第二阶段修复后的5年长期生存率为70±6%，8年为59±7%。
采用两阶段象鼻技术当代治疗广泛性胸主动脉瘤可获得可接受的短期和长期治疗效果。该技术仍然是手术治疗手段的重要组成部分。
