Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Ann Cardiothorac Surg. 2013 May;2(3):280-7. doi: 10.3978/j.issn.2225-319X.2013.05.09.
Hybrid aortic arch replacement has emerged as a safe treatment modality for arch aneurysms, especially in patients of old age and with greater comorbid burden. We assessed our institutional outcomes in patients undergoing Types I and II hybrid aortic arch replacement.
From 2005 to 2012, 685 patients underwent thoracic endovascular repair (TEVAR), of whom 104 had hybrid arch repair (open + endovascular approach). 47 of these patients had treatment for aortic arch aneurysm ± proximal ascending aortic aneurysm. The hybrid repair entailed aortic arch vessel debranching and concomitant/delayed antegrade ± retrograde TEVAR stent grafting of the arch. Type III patients were excluded from the analysis. Data was prospectively maintained.
28 patients had Type I repair, 8 had Type II repair, and 11 had Type III repair. Mean age was 71±8 years. Primary aortic pathology was aneurysm (81%), followed by chronic arch dissection (11%). 14% of patients required reoperative cardiac surgery. Stent graft deployment rate was 100% after arch vessel debranching. Postoperative endoleak rate was zero. Average cardiopulmonary bypass time was 215±64 minutes, with crossclamp time of 70±55 minutes, and circulatory arrest time of 50±17 minutes. Paraplegia rate was 5.5% (n=2), with stroke rate of 8% (n=3) and renal failure rate of 3% (n=1) requiring hemodialysis. In-hospital mortality was 8% (n=3). Mean length of stay was 17.2±14 days. Median follow-up was 30±21 months. Freedom from all-cause mortality was 71%, 60%, and 48% at 1, 3, and 5 years respectively. Aortic reoperation rate was 2.7% (n=1). No patient had Type I or III endoleak at follow-up. Freedom from mortality was improved in cases performed more recently (July 2008 to 2012) than during our early experience (2005 to June 2008) (81% versus 44% at 3 years, P=0.05).
Hybrid aortic arch replacement can be performed with good postoperative and midterm results in a cohort of old patients with significant comorbidity. With greater experience, early and midterm outcomes continue to improve. The hybrid arch technique may represent a technical advancement in the field of aortic arch surgery.
杂交主动脉弓置换术已成为治疗主动脉弓瘤的一种安全治疗方式，尤其适用于老年患者和合并症较多的患者。我们评估了在接受 I 型和 II 型杂交主动脉弓置换术的患者中的机构治疗效果。
从 2005 年到 2012 年，685 例患者接受了胸主动脉腔内修复术（TEVAR），其中 104 例患者接受了杂交弓修复术（开放+腔内治疗）。这些患者中有 47 例患者接受了主动脉弓瘤的治疗±近端升主动脉瘤。杂交修复术包括主动脉弓血管去分支术和同期/逆行经胸主动脉腔内修复术（TEVAR）支架移植物的主动脉弓。III 型患者被排除在分析之外。数据是前瞻性收集的。
28 例患者接受 I 型修复，8 例接受 II 型修复，11 例接受 III 型修复。平均年龄为 71±8 岁。主要的主动脉病变为动脉瘤（81%），其次为慢性主动脉弓夹层（11%）。14%的患者需要再次心脏手术。在进行主动脉弓血管去分支术之后，支架移植物的植入率为 100%。术后内漏发生率为零。体外循环平均时间为 215±64 分钟，主动脉阻断时间为 70±55 分钟，停循环时间为 50±17 分钟。截瘫发生率为 5.5%（n=2），卒中发生率为 8%（n=3），肾衰竭发生率为 3%（n=1），需要血液透析。院内死亡率为 8%（n=3）。平均住院时间为 17.2±14 天。中位随访时间为 30±21 个月。1 年、3 年和 5 年的全因死亡率分别为 71%、60%和 48%。主动脉再次手术率为 2.7%（n=1）。在随访中，没有患者出现 I 型或 III 型内漏。在最近（2008 年 7 月至 2012 年）接受手术的患者中，死亡率明显低于我们早期（2005 年至 2008 年 6 月）的经验（3 年时为 81%对 44%，P=0.05）。
在合并症较多的老年患者中，杂交主动脉弓置换术可以获得良好的术后和中期效果。随着经验的增加，早期和中期结果继续改善。杂交弓技术可能是主动脉弓手术领域的一项技术进步。
