Uchino Gaku, Yunoki Keiji, Sakoda Naoya, Hattori Shigeru, Kawabata Takuya, Saiki Munehiro, Fujita Yasufumi, Hisamochi Kunikazu, Yoshida Hideo, Oba Osamu
Department of Cardiovascular Surgery, Hiroshima Shimin Hospital, Nakaku, Hiroshimashi, Hiroshima Prefecture, Japan.
Department of Endovascular Treatment for Structural Heart and Aortic Disease, Hiroshima Shimin Hospital, Hiroshima Prefecture, Japan.
Interact Cardiovasc Thorac Surg. 2017 Mar 1;24(3):443-449. doi: 10.1093/icvts/ivw360.
There are various treatment strategies for chronic-type B aortic dissection involving the aortic arch. Our aim was to review our surgical experience in the anterolateral thoracotomy with the partial sternotomy approach for chronic-type B aortic dissection involving the aortic arch.
From January 2000 to October 2015, 39 patients underwent the single-stage open surgery for chronic-type B aortic dissection involving the aortic arch using the anterolateral thoracotomy with partial sternotomy approach.
Among the 39 patients, 32 were men (82.1%; mean age at surgery, 61.3 ± 11.9 years), with a mean dissecting aortic aneurysm diameter of 50.21 ± 12.20 mm; 28 patients (71.8%) had patent false lumens of the descending aorta. The median interval from dissection occurrence until surgery was 34.05 ± 52.34 months. Twenty-one patients underwent descending aortic replacement plus total aortic arch replacement and 18 underwent descending aortic replacement (plus partial aortic arch replacement). Overall in-hospital mortality and postoperative stroke rates were 5.1% (2 patients) and 10.3% (4 patients), respectively. Survival rates at 1, 3 and 5 years were 94.7%, 94.7% and 90.2%, respectively. Aortic event-free rates at 1, 3 and 5 years were 90.9%, 90.9% and 80.2%, respectively.
The anterolateral thoracotomy with partial sternotomy approach is a useful surgical procedure with acceptable outcomes for chronic-type B aortic dissection cases involving the aortic arch, when aortic remodelling using thoracic endovascular aortic repair cannot be performed.
对于累及主动脉弓的慢性B型主动脉夹层有多种治疗策略。我们的目的是回顾采用前外侧开胸联合部分胸骨切开术治疗累及主动脉弓的慢性B型主动脉夹层的手术经验。
2000年1月至2015年10月，39例患者采用前外侧开胸联合部分胸骨切开术，接受了一期开放手术治疗累及主动脉弓的慢性B型主动脉夹层。
39例患者中，男性32例（82.1%；手术时平均年龄61.3±11.9岁），主动脉夹层动脉瘤平均直径为50.21±12.20mm；28例患者（71.8%）降主动脉假腔通畅。从夹层发生到手术的中位间隔时间为34.05±52.34个月。21例患者接受了降主动脉置换加全主动脉弓置换，18例接受了降主动脉置换（加部分主动脉弓置换）。总体住院死亡率和术后卒中发生率分别为5.1%（2例患者）和10.3%（4例患者）。1年、3年和5年生存率分别为94.7%、94.7%和90.2%。1年、3年和5年无主动脉事件发生率分别为90.9%、90.9%和80.2%。
对于无法进行胸主动脉腔内修复术进行主动脉重塑的累及主动脉弓的慢性B型主动脉夹层病例，前外侧开胸联合部分胸骨切开术是一种有效的手术方法，其结果可以接受。
