Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Eur J Cardiothorac Surg. 2013 Feb;43(2):406-10. doi: 10.1093/ejcts/ezs296. Epub 2012 May 31.
The combined disease of the aortic arch and the proximal descending aorta remains a surgical challenge. With the 'frozen elephant technique', the ascending aorta, along with the aortic arch, is replaced conventionally and an endovascular stent graft is placed into the descending aorta in the antegrade manner through the open aortic arch, thereby potentially allowing for a 'single-stage' operation. The purpose of this study was to assess the feasibility of a novel four-branched hybrid graft (Vascutek, Scotland).
From April 2010 to August 2011, 34 patients (25 males, age 60 ± 14 years) were operated on [14 aneurysms, 20 dissections (18 acute)]. Ten of these patients had undergone previous cardiac operations. The collapsed endoprosthesis was deployed in the descending aorta through the opened aortic arch. A sewing collar between the graft segments simplified the 'distal' anastomosis. The four-branched graft segment allowed the replacement of the aortic arch and supra-aortic vessels individually. Concomitant procedures were performed if necessary.
There were three deaths within the 30 postoperative days. All of them were of AADA patients. The mean cardiopulmonary bypass time was 254 ± 53 min, aortic cross clamp time was 148 ± 48 min and circulatory arrest time was 48 ± 22 min. Aortic valve-sparing root surgery was performed in 12 patients, Bentall procedure in four, CABG in three and mitral valve repair in two. In one patient, a secondary endovascular extension of the stent graft was necessary to reach the landing zone. In all others, postoperative CT-Scans confirmed the desired results.
The graft adds to the 'frozen elephant trunk' concept for treating the arch and proximal descending aorta. Early experience demonstrates an excellent 30-day survival. Combining the frozen elephant with a four-branched arch graft increases the armament of the surgeon in the treatment of complex and diverse aortic arch pathology.
主动脉弓和降主动脉近端的联合病变仍然是一个手术挑战。采用“冰冻象鼻技术”，常规替换升主动脉和主动脉弓，并通过开放的主动脉弓顺行将血管内支架移植物置于降主动脉中，从而有可能实现“一站式”手术。本研究的目的是评估新型四分支杂交移植物（Vascutek，苏格兰）的可行性。
2010 年 4 月至 2011 年 8 月，34 名患者（25 名男性，年龄 60 ± 14 岁）接受了手术治疗[14 例动脉瘤，20 例夹层（18 例急性）]。其中 10 名患者曾接受过心脏手术。将塌陷的支架移植物通过打开的主动脉弓放置在降主动脉中。移植物段之间的缝合环简化了“远端”吻合。四分支移植物段允许单独替换主动脉弓和主动脉上血管。如有必要，同时进行其他手术。
术后 30 天内有 3 例死亡。他们都是急性主动脉夹层动脉瘤患者。平均体外循环时间为 254 ± 53 分钟，主动脉阻断时间为 148 ± 48 分钟，停循环时间为 48 ± 22 分钟。12 名患者行主动脉瓣保留根部手术，4 名患者行 Bentall 手术，3 名患者行冠状动脉旁路移植术，2 名患者行二尖瓣修复术。在 1 名患者中，需要进行二次血管内支架移植物延伸以到达着陆区。在其他所有患者中，术后 CT 扫描均证实了预期的结果。
该移植物增加了治疗主动脉弓和降主动脉近端的“冰冻象鼻”概念。早期经验表明，30 天生存率非常高。将冰冻象鼻技术与四分支主动脉弓移植物相结合，增加了外科医生治疗复杂多样的主动脉弓病变的手段。
