Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Vascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2014 Jul;148(1):60-4. doi: 10.1016/j.jtcvs.2013.03.045. Epub 2013 Aug 26.
Hybrid operations combining open and endovascular techniques have evolved for patients with complex aortic and coexisting cardiovascular disease. Our objectives were to describe the repair techniques and assess the outcomes in patients undergoing hybrid repair for aneurysm associated with previous aortic coarctation.
From 2004 to 2012, 14 patients underwent hybrid repair by elephant trunk with endovascular completion (n = 5), frozen elephant trunk (n = 8), or antegrade stent grafting (n = 1). The mean age at surgery was 45 ± 13.5 years. Of the 14 patients, 8 underwent supra-aortic arterial revascularization (ascending to subclavian bypass in 5, carotid-subclavian bypass in 2, or ascending to carotid and subclavian bypass in 1). Ten patients had a bicuspid aortic valve, 5 underwent concomitant aortic valve replacement, and 1 underwent valve repair. Six had a hypoplastic arch. Other procedures included ascending aortic repair (n = 4), coronary artery bypass grafting (n = 1), ascending to descending bypass (n = 1), and subclavian aneurysm repair (n = 1). One operation was an emergency, the others were elective. The mean maximum aneurysm diameter was 5.9 ± 1.5 cm. Data were obtained from a prospective database and chart review.
No perioperative mortality, stroke, renal failure, or paraplegia occurred. One patient required prolonged intubation, another required reoperation for postoperative bleeding. Two endoleaks required repeat intervention. The mean length of stay was 9 ± 5.5 days. One late death occurred from hypertensive crisis and associated disseminated intravascular coagulation. At a mean follow-up of 26 months, no aortic growth was found.
Hybrid repair of postcoarctation repair aneurysm is a safe and effective, less-invasive treatment option for patients with complex anatomy and/or concomitant cardiac disease.
对于患有复杂主动脉和并存心血管疾病的患者，结合开放和血管内技术的杂交手术已经发展起来。我们的目的是描述修复技术，并评估接受杂交修复的患者的结果，这些患者的动脉瘤与先前的主动脉缩窄有关。
2004 年至 2012 年，14 名患者接受了杂交修复，包括象鼻手术和血管内完成（n=5）、冷冻象鼻手术（n=8）或顺行支架移植术（n=1）。手术时的平均年龄为 45±13.5 岁。14 名患者中，8 名患者接受了主动脉以上动脉血运重建（5 例升主动脉至锁骨下旁路，2 例颈动脉至锁骨下旁路，1 例升主动脉至颈动脉和锁骨下旁路）。10 例患者为二叶主动脉瓣，5 例患者同时行主动脉瓣置换，1 例患者行瓣膜修复。6 例患者存在升主动脉发育不良。其他手术包括升主动脉修复（n=4）、冠状动脉旁路移植术（n=1）、升主动脉至降主动脉旁路（n=1）和锁骨下动脉瘤修复（n=1）。1 例手术为急诊手术，其余为择期手术。平均最大动脉瘤直径为 5.9±1.5cm。数据来自前瞻性数据库和图表回顾。
无围手术期死亡、中风、肾衰竭或截瘫。1 例患者需要长时间插管，另 1 例患者因术后出血需要再次手术。2 例内漏需要再次介入。平均住院时间为 9±5.5 天。1 例患者死于高血压危象和弥散性血管内凝血。平均随访 26 个月，未发现主动脉生长。
杂交修复后缩窄修复动脉瘤是一种安全有效的微创治疗选择，适用于解剖结构复杂和/或并存心脏疾病的患者。
