Jakob H, Tsagakis K
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Hospital Essen, Germany.
J Cardiovasc Surg (Torino). 2010 Oct;51(5):633-40.
For avoidance of late downstream complications after classic DeBakey type I aortic dissection repair, replacement of the arch with simultaneous antegrade descending stent-grafting using a hybrid prosthesis was applied in acute and chronic aortic dissection. Indication and results were studied.
Between January 2001 and January 2010, 168 patients were operated for acute and chronic aortic dissection (AD). Forty-five patients received an E-vita open stent-graft prosthesis, 29 for acute aortic dissection (AAD) (28 for DeBakey type I, 1 for type III) and 16 for chronic aortic dissection (CAD) (13 type I, 3 type III). Indication was full circular arch dissection, an entry or re-entry tear distal to the left subclavian artery in AAD, and new abdominal malperfusion, rapid growth of the false lumen (FL), impending or contained rupture in CAD.
Hospital mortality was 10% in AAD and 0 in CAD. Complications like new stroke occurred in 7% versus 6%, temporary dialysis in 55% versus 19%, and false lumen obliteration was observed in 93% versus 63% in AAD versus CAD, respectively. Follow-up was 100% at a mean of 19 months. Overall survival at four years was 72% in AAD versus 94% in CAD. FL thrombosis was stable in AAD (92%) and increased to 93% in CAD over time. Freedom from secondary aortic intervention was 90% in AAD and 75% in CAD.
This hybrid approach in patients with AAD and CAD type I is safe when indicated and renders stable results over time down to the stent-graft end. Secondary TEVAR can be easily performed downstream when necessary. The international E-vita open registry data supports this single center results.
为避免经典DeBakey I型主动脉夹层修复术后出现晚期下游并发症，采用混合人工血管对主动脉弓进行置换并同期顺行降主动脉支架植入术治疗急性和慢性主动脉夹层。对其适应证及结果进行研究。
2001年1月至2010年1月，168例急性和慢性主动脉夹层（AD）患者接受手术治疗。45例患者植入E-vita开放式支架人工血管，其中29例为急性主动脉夹层（AAD）（28例为DeBakey I型，1例为III型），16例为慢性主动脉夹层（CAD）（13例为I型，3例为III型）。适应证为全周性主动脉弓夹层、AAD患者左锁骨下动脉远端的入口或再入口撕裂、CAD患者新出现的腹部灌注不良、假腔（FL）快速增大、即将破裂或已包裹性破裂。
AAD患者的医院死亡率为10%，CAD患者为0。新发性卒中之类的并发症在AAD患者中发生率为7%，CAD患者中为6%；临时透析在AAD患者中发生率为55%，CAD患者中为19%；AAD患者和CAD患者中假腔闭塞率分别为93%和63%。随访率为100%，平均随访时间为19个月。AAD患者4年总生存率为72%，CAD患者为94%。AAD患者中FL血栓形成情况稳定（92%），CAD患者中随着时间推移增至93%。AAD患者无需二次主动脉干预的比例为90%，CAD患者为75%。
对于AAD和I型CAD患者，这种混合手术方式在有适应证时是安全的，并且随着时间推移直至支架人工血管末端都能取得稳定的结果。必要时可在下游轻松进行二次胸主动脉腔内修复术（TEVAR）。国际E-vita开放注册数据支持这一单中心研究结果。
