Deriu G, Grego F, Frigatti P, Gerosa G, Piazza M, Bonvini S, Maturi C, Antonello M, Menegolo M
Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery, University of Padua, Padua, Italy.
J Cardiovasc Surg (Torino). 2012 Apr;53(2):143-51.
Aim of the study was to evaluate a single center experience on hybrid treatment for thoracic aortic diseases, including aortic arch and ascending aorta endografting needing a total debranching from descending thoracic aorta and an antegrade endograft deployment from left ventricle.
Between January 2004 and December 2010 48 patients underwent thoracic aorta endografting, with coverage of at least one supra-aortic artery, because of atherosclerotic, dissecting and post-traumatic aneurysms or complications of previous aortic surgery. Supra-aortic trunks revascularization was obtained from ascending aorta, common carotid arteries and, in three cases, from descending thoracic aorta since the unavailability of common inflow sites. In three cases the antegrade endograft introduction through left ventricle (transapical approach, 2 cases) or ascending aorta (one case) was the only possibility for a safe deployment.
Three groups have been identified on the basis of the proximal landing zone. Group A (27 patients): zone 2; Group B (9 patients): zone 1; Group C (12 patients): zone 0. The 30 days mortality was respectively 7.4%, 0% and 16%. Post operative paraplegia occurred in the 7.4% of group A, respiratory insufficiency and infections were the main post-operative complications with an incidence reaching 30% in each group.
Hybrid procedures on aortic arch represent a possible treatment for cases unfit for open surgery despite the complication rates and mortality are not negligible. In selected cases, the endografting can be extended up to beyond the landing zone 0 where an antegrade transventricular endograft deployment and a supra-aortic perfusion from descending thoracic aorta represent a feasible option.
本研究旨在评估单中心关于胸主动脉疾病杂交治疗的经验，包括主动脉弓和升主动脉腔内修复术，该手术需要完全离断胸降主动脉并经左心室顺行植入腔内移植物。
2004年1月至2010年12月期间，48例患者因动脉粥样硬化、夹层和创伤后动脉瘤或既往主动脉手术并发症接受了胸主动脉腔内修复术，且至少覆盖一支主动脉弓上动脉。由于缺乏共同的流入部位，主动脉弓上干血管重建通过升主动脉、颈总动脉进行，3例通过胸降主动脉进行。在3例病例中，经左心室（经心尖途径，2例）或升主动脉（1例）顺行植入腔内移植物是安全植入的唯一选择。
根据近端锚定区确定了三组。A组（27例患者）：2区；B组（9例患者）：1区；C组（12例患者）：0区。30天死亡率分别为7.4%、0%和16%。A组7.4%的患者发生术后截瘫，呼吸功能不全和感染是主要的术后并发症，每组发生率均达30%。
尽管并发症发生率和死亡率不可忽视，但主动脉弓杂交手术对于不适合开放手术的病例是一种可行的治疗方法。在特定病例中，腔内修复术可扩展至0区以外，经心室顺行植入腔内移植物和经胸降主动脉进行主动脉弓上灌注是一种可行的选择。
