Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Eur J Cardiothorac Surg. 2017 Aug 1;52(2):310-318. doi: 10.1093/ejcts/ezx131.
The frozen elephant trunk (FET) technique allows one-stage hybrid repair approach in aortic dissection (AoD). Even if the effect of the FET technique on promoting false lumen (FL) thrombosis has been proved in the past, the relative importance of FL thrombosis on aortic remodelling at different levels of the distal aorta and the magnitude of this effect is not well known. The aim of the study was to evaluate aortic remodelling following a FET technique for AoD.
A multicentre international registry database was searched to identify all patients who underwent a FET procedure for an AoD. A total of 383 patients with AoD were operated on between January 2005 and March 2014 with the FET technique; 137 patients (65 acute AoD and 72 chronic AoD) who survived the initial repair with at least a 1-year follow-up CT scan were included in the study.
The rate of FL thrombosis was higher in the mid-descending thoracic aorta (99.3%) and lower in the distal abdominal aorta (13.9%) but similar between acute and chronic AoDs. The negative remodelling rate was similar between acute and chronic AoDs in the abdominal aorta, but chronic AoD exhibited a higher rate of negative remodelling in the descending thoracic aorta (33% vs 17.5%, P = 0.040).
The FET technique provides an effective treatment for AoD, promoting FL thrombosis and remodelling in the descending thoracic aorta. Changes in the diameter of the aortic lumen depend mainly on the status of the FL and are similar between acute and chronic AoD. Changes in the diameter of true lumen are affected by both the FL status and the timing of the presentation. However, increased FL thrombosis and positive remodelling rates are not maintained at the level of the abdominal aorta, and strict follow-up is mandatory to detect early changes in the aortic dimensions, which may warrant further interventions.
冷冻象鼻技术（FET）允许在主动脉夹层（AoD）中进行一期杂交修复方法。尽管过去已经证明 FET 技术在促进假腔（FL）血栓形成方面的效果，但在不同远端主动脉水平上 FL 血栓形成对主动脉重塑的相对重要性以及这种效果的程度尚不清楚。本研究旨在评估 AoD 中 FET 技术后的主动脉重塑。
在一个多中心国际注册数据库中搜索了所有接受 FET 手术治疗 AoD 的患者。2005 年 1 月至 2014 年 3 月期间，共有 383 例 AoD 患者接受了 FET 手术；137 例患者（65 例急性 AoD 和 72 例慢性 AoD）在初始修复后存活至少 1 年的 CT 扫描，包括在本研究中。
FL 血栓形成的发生率在胸降主动脉中段（99.3%）较高，在腹主动脉下段（13.9%）较低，但在急性和慢性 AoD 之间相似。在腹主动脉中，急性和慢性 AoD 的负重塑率相似，但慢性 AoD 的胸降主动脉负重塑率更高（33%比 17.5%，P ＝0.040）。
FET 技术为 AoD 提供了有效的治疗方法，促进了胸降主动脉 FL 血栓形成和重塑。主动脉管腔直径的变化主要取决于 FL 的状态，在急性和慢性 AoD 之间相似。真腔直径的变化受 FL 状态和发病时间的影响。然而，在腹主动脉水平，FL 血栓形成和正重塑率的增加并未得到维持，必须进行严格的随访以检测主动脉尺寸的早期变化，这可能需要进一步的干预。
