Division of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
Division of Surgery, Hiroshima University, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 2014 Aug;148(2):561-5. doi: 10.1016/j.jtcvs.2012.12.094. Epub 2013 Nov 16.
The operative strategies for retrograde acute type A aortic dissection with a primary intimal tear remain controversial because resection of an intimal tear via a median sternotomy is difficult. We evaluated the frozen elephant trunk technique for treating this type of aortic dissection.
The frozen elephant trunk technique was used for acute retrograde type A aortic dissection with a primary intimal tear in the descending aorta in 25 consecutive patients (16 men, 9 women; median age, 64 years) seen between 1997 and 2011 at the Hiroshima City Asa Hospital. Three patients had Marfan syndrome. Fourteen patients had ischemia of the lower half of the body, 2 had stroke, 3 had coronary ischemia, and 10 had pericardial tamponade.
There were no hospital deaths. Postoperative complications occurred in 2 patients, including stroke and mediastinitis. Two late deaths occurred over a median follow-up period of 58 months (12-169 months), one caused by stroke and the other by colon cancer. Two patients needed additional operations: one required a second operation for descending aorta replacement because of ulceration caused by the stent graft, and the other required an endovascular stent graft because of dilatation of the descending aorta. Computed tomography follow-up scans revealed that the false lumen was completely thrombosed and obliterated in all 25 patients with stent grafts.
The frozen elephant trunk technique for retrograde type A aortic dissection yielded acceptable outcomes, despite the high preoperative morbidity, and might improve the prognosis of dissection.
对于伴有原发内膜撕裂的逆行急性 A 型主动脉夹层，手术策略仍存在争议，因为经正中开胸切除内膜撕裂较为困难。我们评估了冷冻象鼻技术在治疗这种类型的主动脉夹层中的作用。
1997 年至 2011 年，广岛市安佐医院连续治疗了 25 例（男 16 例，女 9 例；中位年龄 64 岁）伴有降主动脉原发内膜撕裂的逆行急性 A 型主动脉夹层患者，采用冷冻象鼻技术。3 例患者患有马凡综合征。14 例患者出现下半身体缺血，2 例发生卒中，3 例发生冠状动脉缺血，10 例发生心包填塞。
无院内死亡。2 例患者发生术后并发症，包括卒中和纵隔炎。中位随访 58 个月（12-169 个月）后，2 例患者死亡，1 例死于卒中，1 例死于结肠癌。2 例患者需要再次手术：1 例因支架移植物导致溃疡而行降主动脉再次置换，1 例因降主动脉扩张而行血管内支架移植物。计算机断层扫描随访显示，所有 25 例接受支架移植物治疗的患者的假腔均完全血栓形成和闭塞。
尽管术前发病率较高，但逆行 A 型主动脉夹层的冷冻象鼻技术可获得良好的结果，可能改善夹层的预后。
