Department of Vascular Surgery, St Thomas' Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Ann Cardiothorac Surg. 2013 May;2(3):300-2. doi: 10.3978/j.issn.2225-319X.2013.05.10.
Innovations in thoracic endovascular aortic repair techniques have enabled its incorporation in open procedures, resulting in a hybrid approach to aortic arch repair. The present study reported our experience with the hybrid technique in managing arch pathologies. Fifty-one patients underwent a hybrid repair of arch pathologies. 10 patients had urgent or emergency surgery, and 8 had previous abdominal aortic aneurysm repair; all were classified as high risk (ASA grade III or IV). Overall 30-day mortality was 9.8% (5/51). Hospital mortality was 30% (3/10) in urgent/emergent surgery and 4.90% (2/41) in elective cases. Ischemic stroke occurred in 11.8% (6/51) of patients, while 5.9% (3/51) experienced paraplegia. Endoleaks occurred in 8 patients, 6 of which were Type 1. Long-term patency rate was 96%. The hybrid technique is a safe, effective and less invasive alternative to open repair of arch pathologies, with comparable outcomes in high-risk patient groups. Patency rates and durability demonstrate the long-term potential of this technique.
胸主动脉腔内修复技术的创新使其能够应用于开放手术中,从而形成了主动脉弓修复的杂交手术方法。本研究报告了我们在处理弓部病变时采用杂交技术的经验。51 例患者接受了弓部病变的杂交修复。10 例为急症或急诊手术,8 例有既往腹主动脉瘤修复史;所有患者均被归类为高危(ASA 分级 III 或 IV)。总的 30 天死亡率为 9.8%(5/51)。急症/急诊手术的院内死亡率为 30%(3/10),择期手术的死亡率为 4.90%(2/41)。11.8%(6/51)的患者发生缺血性脑卒中,5.9%(3/51)发生截瘫。8 例患者发生内漏,其中 6 例为 1 型。长期通畅率为 96%。杂交技术是一种安全、有效、微创的治疗方法,可替代开放手术治疗弓部病变,在高危患者组中具有相似的结果。通畅率和耐久性证明了该技术的长期潜力。