Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.
Department of Cardiovascular Surgery, Nanjing Jinling Hospital, Nanjing, China.
Eur J Cardiothorac Surg. 2018 Feb 1;53(2):317-324. doi: 10.1093/ejcts/ezx308.
Severe ascending aorta disease includes aneurysms, pseudoaneurysms (ascending aorta pseudoaneurysms), penetrating aortic ulcers and Type A aortic dissections. Surgical replacement of the aortic root, ascending aorta or aortic arch is the common treatment for severe ascending aortic disease involving the root, the ascending aorta and/or the arch. Despite good surgical results, there is still a risk for morbidity and mortality following surgery for ascending aorta replacement when elderly patients or patients at high risk for surgery are concerned. Less invasive endovascular treatments for ascending aorta repair are under evaluation, and some reports appeared in the available literature in the last decade. However, clinical series or randomized studies are not yet available, and the use of these techniques is still questionable. In this study, we analysed the outcomes of reported cases of endovascular treatment for ascending aorta disease, excluding Type A aortic dissection. We reviewed reports published until February 2017, and we evaluated the employed technology, the devices, the procedural steps and the outcomes. A total of 26 articles reported 67 patients (mean age 65 ± 17 years) who received endovascular treatment for ascending aorta disease: aneurysms, ascending aorta pseudoaneurysms, penetrating aortic ulcers, intramural haematoma, thrombosis, iatrogenic coarctation and aortic rupture. Complications included endoleak (9 cases), stroke (3 cases), non-ST-elevation myocardial infarction (1 case) and splenic infarction (1 case). Three patients required conversion to open surgery, and 1 patient underwent endovascular reintervention. Early mortality was 2.9%. As an alternative treatment for ascending aorta disease in selected high-risk patients, the endovascular repair will gain popularity, but further analysis is required.
严重的升主动脉疾病包括动脉瘤、假性动脉瘤（升主动脉假性动脉瘤）、穿透性主动脉溃疡和 A 型主动脉夹层。对于累及根部、升主动脉和/或主动脉弓的严重升主动脉疾病，手术置换主动脉根部、升主动脉或主动脉弓是常见的治疗方法。尽管手术效果良好，但对于老年患者或手术风险较高的患者，进行升主动脉置换手术后仍存在发病和死亡的风险。用于升主动脉修复的微创血管内治疗方法正在评估中，在过去十年的可用文献中出现了一些报告。然而，目前还没有临床系列或随机研究，这些技术的应用仍存在疑问。在这项研究中，我们分析了报告的用于治疗升主动脉疾病的血管内治疗病例的结果，不包括 A 型主动脉夹层。我们回顾了截至 2017 年 2 月发表的报告，并评估了所采用的技术、器械、手术步骤和结果。共有 26 篇文章报告了 67 例（平均年龄 65±17 岁）接受血管内治疗升主动脉疾病的患者：动脉瘤、升主动脉假性动脉瘤、穿透性主动脉溃疡、壁内血肿、血栓形成、医源性缩窄和主动脉破裂。并发症包括内漏（9 例）、中风（3 例）、非 ST 段抬高型心肌梗死（1 例）和脾梗死（1 例）。3 例患者需要转为开放手术，1 例患者接受了血管内再介入治疗。早期死亡率为 2.9%。作为一种替代治疗方法，在选择的高危患者中，血管内修复将越来越受欢迎，但需要进一步分析。
