Mutsuga Masato, Narita Yuji, Araki Yoshimori, Maekawa Atsuo, Oshima Hideki, Usui Akihiko, Ueda Yuichi
Graduate School of Medicine, Department of Cardiac Surgery, Nagoya University, 65 Tsurumaicyo Syowaku, Nagoya, Aichi 466-8550, Japan.
Interact Cardiovasc Thorac Surg. 2010 Jul;11(1):15-9. doi: 10.1510/icvts.2009.223099. Epub 2010 Apr 12.
This study evaluated the clinical advantage of a novel technique to reconstruct a true lumen with aortic wall tailoring for aortic repair (aortic tailoring) or the reimplantation of intercostal arteries (vascular tube) in a chronic type B aortic dissection. Thirty-three consecutive extended thoracoabdominal aortic repairs have been performed for chronic type B dissection since 2000. The novel strategy was applied in 17 cases since 2004 including eight cases of aortic repair (group A) and nine cases of a vascular tube (group B). The other 16 cases were graft interposition in five and no reimplantation in 11 for group C. There were no surgical deaths in either group A or B, and only one late death in group C. No patients sustained transient or permanent paraplegia in group A and B, while three cases of paraplegia occurred in group C (18.8%). All of the intercostal arteries were well preserved in group A and an average of 9.8 intercostal arteries for nine patients were reimplantated in group B. The present technique can optimally preserve the intercostal arteries maximally and showed an excellent surgical mortality and morbidity, especially with regard to the protection of the spinal cord.
本研究评估了一种新技术的临床优势，该技术通过裁剪主动脉壁来重建真腔以进行主动脉修复（主动脉裁剪）或在慢性B型主动脉夹层中重新植入肋间动脉（血管移植管）。自2000年以来，已连续对33例慢性B型夹层进行了胸腹主动脉修复术。自2004年起，该新技术应用于17例患者，其中包括8例主动脉修复术（A组）和9例血管移植管植入术（B组）。另外16例为C组，其中5例采用移植物植入，11例未进行重新植入。A组和B组均无手术死亡病例，C组仅有1例晚期死亡。A组和B组均无患者发生短暂性或永久性截瘫，而C组有3例发生截瘫（18.8%）。A组所有肋间动脉均得以良好保留，B组9例患者平均重新植入了9.8条肋间动脉。目前的技术能够最大程度地优化保留肋间动脉，并显示出极佳的手术死亡率和发病率，尤其是在脊髓保护方面。
