Verhoye Jean-Philippe, Anselmi Amedeo, Kaladji Adrien, Flécher Erwan, Lucas Antoine, Heautot Jean-François, Beneux Xavier, Fouquet Olivier
Department of Thoracic, Cardiac and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
Eur J Cardiothorac Surg. 2014 May;45(5):812-7. doi: 10.1093/ejcts/ezt477. Epub 2013 Sep 26.
To describe the early and mid-term clinical and instrumental results of the frozen elephant trunk (FET) procedure using the recent Evita Open Plus hybrid endoprosthesis for elective one-stage treatment of extensive thoracic aortic disease.
We reviewed 16 patients undergoing FET for post-dissection aneurysm (50%), true aneurysm (31%) or other aetiologies (19%), through median sternotomy and hypothermic circulatory arrest. An average 14 ± 7.6-month follow-up with regular contrast-enhanced control computed tomography scans was available. Four patients received preliminary carotid-subclavian bypass to improve spinal cord protection. Distal extension through endovascular deployment of stent-grafts into the descending aorta was performed during the same procedure in 3 patients. Concomitant procedures on the ascending aorta/root were done in 25% of cases.
There were no cases of operative mortality. Cases of neither cerebral stroke nor postoperative paraplegia were observed. Two cases of transient paraparesis and 1 case of Brown-Séquard syndrome occurred. At follow-up, there were no cases of endoleak or endotension. One patient was reoperated for distal completion (thoracoabdominal aortic replacement).
The FET using the Evita Open Plus device is a reliable and versatile treatment for one-step management of extensive disease of the aortic arch and the descending aorta. This strategy should be reserved for patients having limited preoperative comorbidities and good functional status.
描述使用最新的Evita Open Plus混合式腔内修复器械进行冷冻象鼻术（FET）治疗广泛性胸主动脉疾病的早期和中期临床及影像学结果，该治疗用于选择性一期治疗。
我们回顾了16例接受FET治疗的患者，病因包括夹层后动脉瘤（50%）、真性动脉瘤（31%）或其他病因（19%），通过正中胸骨切开术和低温循环停止进行手术。平均随访14±7.6个月，定期进行对比增强计算机断层扫描。4例患者接受了预防性颈总动脉-锁骨下动脉旁路移植术以改善脊髓保护。3例患者在同一手术过程中通过血管腔内植入支架型人工血管将远端延伸至降主动脉。25%的病例同时进行了升主动脉/主动脉根部的相关手术。
无手术死亡病例。未观察到脑卒中和术后截瘫病例。发生了2例短暂性轻截瘫和1例布朗 - 塞卡尔综合征病例。随访时，无内漏或内张力病例。1例患者因远端完成手术（胸腹主动脉置换术）而再次手术。
使用Evita Open Plus器械的FET是一种可靠且通用的治疗方法，用于一步治疗主动脉弓和降主动脉的广泛性疾病。该策略应保留给术前合并症有限且功能状态良好的患者。
