An Zhao, Song Zhigang, Tang Hao, Han Lin, Xu Zhiyun
Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
Heart Lung Circ. 2018 May;27(5):629-634. doi: 10.1016/j.hlc.2017.03.168. Epub 2017 May 29.
In this study, we investigated the surgical strategy for managing retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) by reporting our experience and literature review.
From June 2011 to January 2014, nine patients with RTAD received surgical repair in our institution. The mean age of these patients was 49.3±10.7 years. Data on these RTAD patients was retrospectively collected for further analysis. Literature related to RTAD after TEVAR from 2006 to 2014 was reviewed using the following terms: thoracic endovascular aortic repair, retrograde type A dissection, stent induced new entry, and surgical repair.
We adopted a total arch replacement combined with a stented elephant trunk implantation and partly preserved the previous TEVAR stent during operation. In-hospital death rate was 11.1% (one of nine). One patient (11.1%) developed paraparesis after operation. No late deaths or complications occurred during follow-up. Literature review identified four articles on the surgical management of RTAD after TEVAR. Our literature review also showed total arch replacement with the stented elephant trunk implantation might be associated with a better prognosis.
Retrograde type A dissection is a serious complication after TEVAR. The induced factors of RTAD were various and complicated. Our experience and literature review indicates a combination of total arch replacement, stented elephant trunk implantation and partly preserving the previous TEVAR stent is feasible for the surgical repair of RTAD after TEVAR.
在本研究中，我们通过报告自身经验并进行文献回顾，探讨了胸主动脉腔内修复术（TEVAR）后逆行A型夹层（RTAD）的手术策略。
2011年6月至2014年1月，9例RTAD患者在我院接受了手术修复。这些患者的平均年龄为49.3±10.7岁。对这些RTAD患者的数据进行回顾性收集以作进一步分析。使用以下检索词对2006年至2014年与TEVAR术后RTAD相关的文献进行了回顾：胸主动脉腔内修复术、逆行A型夹层、支架导致的新破口以及手术修复。
我们采用全弓置换联合带支架象鼻植入术，并在手术中部分保留了先前的TEVAR支架。住院死亡率为11.1%（9例中的1例）。1例患者（11.1%）术后出现截瘫。随访期间未发生晚期死亡或并发症。文献回顾确定了4篇关于TEVAR术后RTAD手术治疗的文章。我们的文献回顾还显示，全弓置换联合带支架象鼻植入术可能与更好的预后相关。
逆行A型夹层是TEVAR术后的一种严重并发症。RTAD的诱发因素多样且复杂。我们的经验和文献回顾表明，全弓置换、带支架象鼻植入术以及部分保留先前的TEVAR支架相结合对于TEVAR术后RTAD的手术修复是可行的。
