Hoffman Andras, Parker Jack A T C, Raweh Ayman, Autschbach Rüdiger
Department of Cardiothoracic and Vascular Surgery, University Hospital of RWTH Aachen, Pauwelstrasse 30, Aachen, Germany.
Asian Cardiovasc Thorac Ann. 2011 Apr;19(2):123-7. doi: 10.1177/0218492311400761.
Following successful repair of Type A dissection, late morbidity and mortality depend on the progression of residual chronic Type B dissection. To avoid the development of late aneurysms of the descending thoracic aorta, a persistent aortic false lumen around the stent-graft can be prevented by remodeling the thoracic aorta. Ten consecutive patients (mean age: 56 years) with acute Type A dissection underwent a "frozen elephant trunk operation" with the E-vita hybrid prosthesis, under deep hypothermic circulatory arrest, between October 2009 and April 2010. The thoracic aorta was restored to its original size. Computed tomography was used to size the aortic diameter. All patients survived and were routinely discharged. Postoperative computed tomography showed no remaining false lumen and no distal organ ischemia in any patient. No new neurological complication was recorded. Two patients suffered postoperative pulmonary arterial embolism; one underwent embolectomy. Restoration of the thoracic aorta is a safe procedure to close the false lumen during the primary operation for acute Type A dissection. However, the diameter of the stent should reflect the overall aortic size, independent of the diameter of the true lumen.
在A型主动脉夹层成功修复后，晚期发病率和死亡率取决于残余慢性B型主动脉夹层的进展情况。为避免胸降主动脉晚期动脉瘤的发生，可通过重塑胸主动脉来防止支架移植物周围持续存在主动脉假腔。2009年10月至2010年4月期间，10例连续的急性A型主动脉夹层患者（平均年龄：56岁）在深低温循环停搏下，使用E-vita混合人工血管进行了“象鼻冷冻手术”。胸主动脉恢复到原来的大小。使用计算机断层扫描测量主动脉直径。所有患者均存活并常规出院。术后计算机断层扫描显示，所有患者均无残余假腔，无远端器官缺血。未记录到新的神经并发症。2例患者术后发生肺动脉栓塞；1例接受了栓子切除术。在急性A型主动脉夹层一期手术中，重塑胸主动脉是闭合假腔的一种安全方法。然而，支架的直径应反映主动脉的整体大小，而与真腔直径无关。
