Kobayashi Misato, Chaykovska Lyubov, van der Loo Bernd, Nguyen Thi Dan Linh, Puippe Gilbert, Salzberg Sacha, Ueda Hideki, Maisano Francesco, Pecoraro Felice, Lachat Mario
Kawaminami Hospital, Kawaminami Koyu Miyazaki, Japan.
Clinic for Cardiovascular Surgery, Zurich University Hospital, Zurich, Switzerland
Vascular. 2016 Oct;24(5):523-30. doi: 10.1177/1708538115627728. Epub 2016 Jan 14.
To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment.
Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters.
In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.
描述简化的冰冻象鼻技术（sFETT）用于复杂急性A型主动脉夹层（AAAD）治疗的长期经验。
2001年1月至2012年12月期间，34例（平均年龄59.9±11.0岁）复杂AAAD（DeBakey I型）患者接受了包括sFETT在内的急诊手术。sFETT包括用明胶-间苯二酚粘合剂粘合主动脉弓壁层，并在主动脉弓或近端降主动脉中进行电视辅助顺行性开放弓主动脉支架移植物置入。除sFETT外，采用标准技术处理主动脉根部。30天死亡率为14.7%（5例患者），原因包括出血（1例）、多器官功能衰竭（2例）和结肠缺血（2例）。术后并发症包括神经系统（2例）、肾脏（1例）和心肺并发症（4例）以及伤口感染（1例）。平均随访时间为74.4±45.0个月。随访1年、5年和13年时的实际生存率分别为73.5%、70.2%和58.5%。6例患者在长期随访中死于心力衰竭（1例）和不明原因（5例）。5例患者在中长期随访期间因主动脉弓（3例）或主-髂动脉瘤进展（2例）需要再次手术。其余患者的夹层主动脉大多出现假腔闭塞且主动脉直径稳定，病情进展良好。
在AAAD患者中，我们系列中使用的sFETT是一种修复主动脉弓的简便且安全的技术。sFETT后的长期结果显示，在长达13年的随访中假腔闭塞且主动脉直径稳定。
