Division of Cardiovascular Surgery, Hiroshima-city Asa General Hospital, 2-1-1, Kabe-minami, Asa-Kita-Ku, Hiroshima 731-0293, Japan.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):913-7. doi: 10.1016/j.jtcvs.2009.08.018. Epub 2009 Nov 11.
The objective of this report is to elucidate the feasibility of the frozen elephant trunk technique as a one-stage operation for extensive arteriosclerotic aneurysms and to investigate the long-term durability and efficacy of this procedure from our 11 years of experience.
The subjects were 58 consecutive patients who electively received the frozen elephant trunk technique for arteriosclerotic aneurysms involving the aortic arch and the descending aorta between September 1997 and September 2008. Concomitant procedures included 15 coronary artery bypass grafts, 2 aortic valve replacements, 1 aortic root replacement, and 3 maze procedures. The stent graft was delivered to the seventh thoracic vertebra level (Th7) in 22, Th8 in 26, Th9 in 8, and Th10 in 2 patients. Cerebrospinal fluid drainage was administered preoperatively in 10 (17.2%) patients.
Operative mortality within 30 days was 0 of 58. There was 1 in-hospital death. Perioperative morbidity included strokes and spinal cord injury in 2 (3.4%) patients each. During the mean follow-up period of 54.2 +/- 36.9 months, there were 9 (15.5%) late deaths, and 7 (12.1%) patients required additional intervention. The 8-year survival was 65.5%, the overall 8-year aortic event free survival was 72.8%, and the 8-year event free survival on the site of the stent graft was 94.8%. A follow-up computed tomographic image was available for 86.2% (50/58) of patients who survived longer than 6 months. The size of the aneurysm increased in 1 (2.0%) patient, was not changed in 6 (12.0%) patients, shrank in 34 (68.0%) patients, and was obliterated in 9 (18.0%) patients.
The frozen elephant trunk for extensive aortic aneurysms had long-term durability and efficacy and might become the alternative treatment for extended aortic replacement.
本研究旨在阐述应用冷冻象鼻技术一期治疗广泛粥样硬化性动脉瘤的可行性，并通过我们 11 年的经验探讨该术式的长期疗效和安全性。
1997 年 9 月至 2008 年 9 月，连续 58 例患者因粥样硬化性主动脉弓和降主动脉动脉瘤择期接受冷冻象鼻技术治疗。同期行 15 例冠状动脉旁路移植术、2 例主动脉瓣置换术、1 例主动脉根部置换术和 3 例迷宫手术。22 例支架移植物送达第 7 胸椎水平（Th7），26 例送达第 8 胸椎水平（Th8），8 例送达第 9 胸椎水平（Th9），2 例送达第 10 胸椎水平（Th10）。10 例（17.2%）患者术前行脑脊液引流。
58 例患者中，术后 30 天内死亡率为 0/58。院内死亡 1 例。围手术期并发症包括 2 例（3.4%）脑卒中，2 例（3.4%）脊髓损伤。中位随访 54.2±36.9 个月期间，9 例（15.5%）患者死亡，7 例（12.1%）患者需要再次干预。8 年生存率为 65.5%，总体 8 年主动脉无事件生存率为 72.8%，支架移植物部位 8 年无事件生存率为 94.8%。86.2%（50/58）的存活患者进行了随访 CT 检查，其中 1 例（2.0%）患者动脉瘤增大，6 例（12.0%）患者动脉瘤大小无变化，34 例（68.0%）患者动脉瘤缩小，9 例（18.0%）患者动脉瘤完全闭塞。
对于广泛的主动脉瘤，冷冻象鼻技术具有长期疗效和安全性，可能成为广泛主动脉置换的替代治疗方法。
