Sun Li-Zhong, Qi Rui-Dong, Chang Qian, Zhu Jun-Ming, Liu Yong-Min, Yu Chun-Tao, Lv Bin, Zheng Jun, Tian Liang-Xin, Lu Jin-Guo
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Thorac Cardiovasc Surg. 2009 Oct;138(4):892-6. doi: 10.1016/j.jtcvs.2009.02.041. Epub 2009 Apr 25.
Surgical treatment of chronic Stanford type A aortic dissection using total arch replacement combined with stented elephant trunk implantation is controversial owing to the visceral arteries and intercostal arteries originating from the false lumen.
Eighty-nine patients (mean age, 45.67 +/- 10.18 years; range, 21-68 years) with chronic type A dissection underwent total arch replacement combined with stented elephant trunk implantation between April 2003 and March 2007. Careful assessment of the visceral arteries and location of entry and re-entry was done before surgery. Postoperative patency of the visceral arteries and diameter of the aortic artery and the residual false lumen were evaluated by computed tomography.
One (1.12%) hospital death and 2 (2.25%) late deaths occurred at a mean follow-up of 28.5 months (range, 8-52 months). Visceral malperfusion was not observed. Two patients had spinal cord injury and recovered during follow-up. One patient had a transient neurologic deficit and recovered completely before discharge. One patient underwent thoracoabdominal aortic replacement for aneurysmal dilatation of the residual descending aorta 3 months after the operation. Thrombus obliteration of the false lumen at the distal edge of the stented elephant trunk and at the diaphragmatic level was 94.2% (81/86) and 61.6% (53/86), respectively.
Satisfactory results with low morbidity and mortality were obtained. No visceral malperfusion and a low risk of postoperative spinal cord injury favor this technique in patients with chronic type A dissection.
由于内脏动脉和肋间动脉起源于假腔，采用全弓置换联合带支架象鼻植入术治疗慢性Stanford A型主动脉夹层存在争议。
2003年4月至2007年3月期间，89例（平均年龄45.67±10.18岁；范围21 - 68岁）慢性A型夹层患者接受了全弓置换联合带支架象鼻植入术。术前仔细评估内脏动脉以及入口和再入口的位置。术后通过计算机断层扫描评估内脏动脉的通畅情况、主动脉直径和残余假腔。
平均随访28.5个月（范围8 - 52个月），发生1例（1.12%）医院死亡和2例（2.25%）晚期死亡。未观察到内脏灌注不良。2例患者发生脊髓损伤，随访期间恢复。1例患者有短暂性神经功能缺损，出院前完全恢复。1例患者术后3个月因残余降主动脉瘤样扩张接受胸腹主动脉置换。带支架象鼻远端边缘和膈肌水平假腔的血栓闭塞率分别为94.2%（81/86）和61.6%（53/86）。
获得了低发病率和死亡率的满意结果。无内脏灌注不良且术后脊髓损伤风险低，使得该技术适用于慢性A型夹层患者。
