Cheng Lijian, Huang Fuhua, Chang Qian, Zhu Junming, Yu Cuntao, Liu Yongmin, Zhang Haitao, Zheng Jun, Sun Li-Zhong
Department of Cardiovascular Surgery, Cardiovascular Institute, Peking Union Medical College, Beijing, China.
Heart Surg Forum. 2010 Feb;13(1):E1-6. doi: 10.1532/HSF98.20091081.
The objective is to present a method for maintaining the spinal cord blood supply and our midterm results for using a tetrafurcate graft in extensive thoracoabdominal aortic aneurysm (TAAA) repair.
From August 2003 to October 2007, we used a tetrafurcate graft to perform repairs to TAAAs of Crawford extent II in 63 consecutive patients. The mean age of this group of patients was 39.98 +/- 10.62 years, and 46 (73%) of them were male. All of the procedures were performed under profound hypothermia with a short interval of circulatory arrest. T6 to T12 intercostal arteries were reconstructed as a "neo-intercostal artery" (N-IA) and were connected to an 8-mm sidearm of the graft to maintain the spinal cord blood supply. Visceral arteries were joined into a patch and were anastomosed to the end of the main graft. The left renal artery was anastomosed to an 8-mm sidearm or joined to the patch. The other 10-mm sidearms were anastomosed to iliac arteries.
With 100% follow-up, the early-mortality rate was 7.94%. The incidence of cerebral complications was 9.52%. Temporary paraplegia was observed in 2 patients, and paraparesis occurred in 1 patient. Pulmonary complication was the most common morbidity in this group (25.40%). Two patients with Marfan syndrome had N-IA artery pseudoaneurysms during follow-up. The mean survival time of this group was 50.64 +/- 2.13 months, with survival rates of 92.06% after 1 year, 88.38% after 2 years, and 86.11% after 3 years.
The N-IA may play an important role in spinal cord protection, and N-IA pseudoaneurysm should be avoided in Marfan syndrome patients. The use of a tetrafurcate graft is a reliable method for TAAA repair, with satisfactory midterm results.
介绍一种维持脊髓血供的方法以及我们使用四分支移植物修复广泛胸腹主动脉瘤（TAAA）的中期结果。
2003年8月至2007年10月，我们连续对63例CrawfordⅡ型TAAA患者使用四分支移植物进行修复。该组患者的平均年龄为39.98±10.62岁，其中46例（73%）为男性。所有手术均在深度低温及短时间循环阻断下进行。将T6至T12肋间动脉重建为“新肋间动脉”（N-IA），并连接至移植物的8mm侧支以维持脊髓血供。内脏动脉被拼接成补片并与主移植物末端吻合。左肾动脉与8mm侧支吻合或连接至补片。其他10mm侧支与髂动脉吻合。
随访率100%，早期死亡率为7.94%。脑部并发症发生率为9.52%。2例患者出现暂时性截瘫，1例患者出现轻瘫。肺部并发症是该组最常见的并发症（25.40%）。2例马凡综合征患者在随访期间出现N-IA动脉假性动脉瘤。该组的平均生存时间为50.64±2.13个月，1年生存率为92.06%，2年生存率为88.38%，3年生存率为86.11%。
N-IA可能在脊髓保护中起重要作用，马凡综合征患者应避免发生N-IA假性动脉瘤。使用四分支移植物是修复TAAA的可靠方法，中期结果满意。
