Czerny Martin, König Tobias, Reineke David, Sodeck Gottfried H, Rieger Maximilian, Schoenhoff Florian, Basciani Reto, Jenni Hansjörg, Schmidli Jürg, Carrel Thierry P
Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
Interact Cardiovasc Thorac Surg. 2013 Sep;17(3):532-6. doi: 10.1093/icvts/ivt260. Epub 2013 Jun 19.
To analyse the results after elective open total aortic arch replacement.
We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012.
In-hospital mortality was 5.1% (n = 2) and perioperative neurological injury was 12.8% (n = 5). The indication for surgery was degenerative aneurysmal disease in 59% (n = 23) and late aneurysmal formation following previous surgery of type A aortic dissection in 35.9% (n = 14); 5.1% (n = 2) were due to anastomotical aneurysms after prior ascending repair. Fifty-nine percent (n = 23) of the patients had already undergone previous proximal thoracic aortic surgery. In 30.8% (n = 12) of them, a conventional elephant trunk was added to total arch replacement, in 28.2% (n = 11), root replacement was additionally performed. Median hypothermic circulatory arrest time was 42 min (21-54 min). Selective antegrade cerebral perfusion was used in 95% (n = 37) of patients. Median follow-up was 11 months [interquartile range (IQR) 1-20 months]. There was no late death and no need for reoperation during this period.
Open total aortic arch replacement shows very satisfying results. The number of patients undergoing total arch replacement as a redo procedure and as a part of a complex multisegmental aortic pathology is high. Future strategies will have to emphasize neurological protection in extensive simultaneous replacement of the aortic arch and adjacent segments.
分析择期开放性全主动脉弓置换术后的结果。
我们分析了39例患者（中位年龄63岁，中位逻辑欧洲心脏手术风险评估系统评分为18.4），这些患者在2005年至2012年间接受了择期开放性全主动脉弓置换术。
住院死亡率为5.1%（n = 2），围手术期神经损伤发生率为12.8%（n = 5）。手术指征为退行性动脉瘤疾病的占59%（n = 23），既往A型主动脉夹层手术后继发动脉瘤形成的占35.9%（n = 14）；5.1%（n = 2）是由于先前升主动脉修复术后吻合口动脉瘤。59%（n = 23）的患者此前已接受过近端胸主动脉手术。其中30.8%（n = 12）在全主动脉弓置换术中加做了传统象鼻手术，28.2%（n = 11）额外进行了根部置换。低温循环阻断的中位时间为42分钟（21 - 54分钟）。95%（n = 37）的患者采用了选择性顺行脑灌注。中位随访时间为11个月[四分位间距（IQR）1 - 20个月]。在此期间无晚期死亡，也无需再次手术。
开放性全主动脉弓置换术显示出非常令人满意的结果。作为再次手术以及作为复杂多节段主动脉病变一部分而接受全主动脉弓置换术的患者数量较多。未来的策略将不得不强调在广泛同时置换主动脉弓及相邻节段时的神经保护。
