Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Ann Thorac Surg. 2011 Nov;92(5):1663-70; discussion 1670. doi: 10.1016/j.athoracsur.2011.06.027. Epub 2011 Oct 31.
Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.
Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion.
Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively.
The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.
由于主动脉广泛受累，慢性夹层的手术治疗仍然是一项挑战。我们进行了一项多中心经验研究，描述了使用冷冻象鼻技术（FET）治疗这种复杂病变的多中心经验。
2005 年 1 月至 2010 年 5 月期间，240 例患者接受 FET 技术治疗，并在国际 E-vita Open 注册中心收集了他们的临床数据。本研究人群为 90 例接受慢性主动脉夹层（A型，77%）手术的患者。这些 90 例患者的平均年龄为 57 ± 12 岁，72 例（80%）为男性。62 例（69%）患者曾接受过主动脉手术。所有研究中的手术均在顺行选择性脑灌注的辅助下进行。
84 例（93%）患者行全主动脉弓置换术。体外循环、心肌缺血、脑灌注和内脏缺血时间分别为 243 ± 65、145 ± 48、86 ± 24 和 75 ± 22 分钟。住院死亡率为 12%（11 例）。1 例患者死于脑卒中，8 例（9%）患者死于缺血性脊髓损伤。术后及随访期间，通过计算机断层扫描评估患者主动脉的假腔（FL）。在第一次和最后一次术后检查时，FL 在象鼻周围完全血栓形成的比例分别为 69%和 79%。4 年生存率和免于主动脉再次手术的比例分别为 78%±5%和 96%±3%。
FET 技术治疗慢性主动脉夹层（AD）是可行的，效果可观。与慢性 AD 常规修复方法相比，使用该技术的主动脉再次手术率似乎较低。缺血性脊髓损伤是 FET 技术的一个令人担忧的并发症，但似乎与 FL 血栓形成无关。
