Kang W C, Ko Y-G, Oh P C, Shin E K, Park C-H, Choi D, Youn Y N, Lee D Y
Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Cardiothoracic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea.
Eur J Vasc Endovasc Surg. 2016 Aug;52(2):173-8. doi: 10.1016/j.ejvs.2016.06.001. Epub 2016 Jun 23.
Total arch transposition (TAT) during hybrid endovascular repair for aortic arch disease is believed to allow a better landing zone, but also to be associated with higher peri-operative mortality than partial arch transposition (PAT). Information on this issue is limited.
This study was a retrospective analysis. All 53 consecutive patients with aortic arch disease (41 males, mean age 65.0 years) who underwent hybrid endovascular repair with TAT (zone 0, n=20) or PAT (zone 1 or 2, n=33) from 2008 to 2014 were analyzed retrospectively. The peri-operative and late outcomes of these two groups were compared.
Baseline characteristics, including EuroSCORE II results, were similar in the two groups. After procedures, peri-operative mortalities and stroke rates were similar in the two groups (5.0% vs. 9.1%, p=1.000, and 10.0% vs. 6.1%, p=.627). Interestingly, all four strokes occurred in patients with a type III aortic arch irrespective of transposition type. Primary success rates (80.0% vs. 69.7%, p=.527) and type I endoleak incidences (20.0% vs. 27.3%, p=.744) were not significantly different. During follow up (mean duration 36.9 months), overall survival (89.7% vs. 87.4% at 1 year and 89.7% vs. 79.3% at 3 years; p=.375) and re-intervention free survival rates (78.6% vs. 92.0% at 1 year; 72.0% vs. 62.2% at 3 years, p=.872) were similar in the two groups.
Morbidity and mortality were high within the first year of hybrid endovascular therapy for aortic arch disease, implying that candidates for hybrid procedures need to be selected carefully. Hybrid endovascular repair with TAT was found to have peri-operative mortality, stroke, and long-term survival rates comparable with PAT, so hybrid endovascular repair may be considered, irrespective of type of arch reconstruction, when clinically indicated.
在主动脉弓疾病的杂交血管腔内修复术中，全弓转位（TAT）被认为能提供更好的着陆区，但也被认为与比部分弓转位（PAT）更高的围手术期死亡率相关。关于这个问题的信息有限。
本研究为回顾性分析。对2008年至2014年连续接受TAT（0区，n = 20）或PAT（1区或2区，n = 33）杂交血管腔内修复术的53例主动脉弓疾病患者（41例男性，平均年龄65.0岁）进行回顾性分析。比较这两组患者的围手术期和远期结局。
两组患者的基线特征，包括欧洲心脏手术风险评估系统（EuroSCORE）II评分结果相似。手术后，两组患者的围手术期死亡率和卒中发生率相似（5.0% 对9.1%，p = 1.000；10.0% 对6.1%，p = 0.627）。有趣的是，所有4例卒中均发生在III型主动脉弓患者中，与转位类型无关。一期成功率（80.0% 对69.7%，p = 0.527）和I型内漏发生率（20.0% 对27.3%，p = 0.744）无显著差异。在随访期间（平均时长36.9个月），两组患者的总生存率（1年时为89.7% 对87.4%，3年时为89.7% 对79.3%；p = 0.375）和无再次干预生存率（1年时为78.6% 对92.0%；3年时为72.0% 对62.2%，p = 0.872）相似。
主动脉弓疾病杂交血管腔内治疗的第一年发病率和死亡率较高，这意味着需要谨慎选择杂交手术的候选患者。发现TAT杂交血管腔内修复术的围手术期死亡率、卒中发生率和长期生存率与PAT相当，因此在临床有指征时，无论弓重建类型如何，均可考虑杂交血管腔内修复术。
