Kozlov Boris N, Panfilov Dmitri S, Ponomarenko Igor V, Miroshnichenko Andrey G, Nenakhova Aleksandra A, Maksimov Alexander I, Shipulin Vladimir M
Cardiovascular Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.
Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):972-976. doi: 10.1093/icvts/ivx432.
The aim of the study was to access the extended occlusion of the intercostal arteries by a stent graft in the development of postoperative spinal cord injury during aortic arch surgery using the frozen elephant trunk technique.
A total of 37 consecutive patients underwent total aortic arch surgery using the frozen elephant trunk technique between March 2012 and July 2017. The mean age of the patients was 54.7 ± 10.5 years. Type A and Type B aortic dissections were the indications for surgery. Moderate hypothermia and antegrade cerebral perfusion via the innominate artery were utilized. The mean diameter of the implanted stent graft was 27.7 ± 2 mm (range 24-30 mm).
No permanent spinal cord injuries occurred. The distal edge of the stent graft was in the T7-T12 range. Its lower edge was implanted at the T9-T12 level in 25 (67.6%) cases. Preoperatively, the mean number of intercostal arteries was 10 ± 1 on the left side and 10 ± 2 on the right side (P = 0.59). Postoperatively, the mean number of open segmental arteries was 3 ± 2 on the left and 4 ± 1 on the right (P = 0.003).
The frozen elephant trunk procedure is associated with the occlusion of most (two-thirds) of the intercostal arteries. Maintenance of adequate blood flow in the subclavian and iliac arteries is an integral prerequisite for a favourable outcome. The level of the deployment of the distal edge of the stent graft does not play a defining role.
本研究旨在探讨在使用冰冻象鼻技术进行主动脉弓手术时，通过支架型人工血管扩展肋间动脉闭塞情况与术后脊髓损伤发生发展之间的关系。
2012年3月至2017年7月期间，共有37例连续患者接受了使用冰冻象鼻技术的全主动脉弓手术。患者的平均年龄为54.7±10.5岁。手术适应证为A型和B型主动脉夹层。采用中度低温及经无名动脉顺行脑灌注。植入的支架型人工血管平均直径为27.7±2mm（范围24 - 30mm）。
未发生永久性脊髓损伤。支架型人工血管的远端边缘位于T7 - T12范围内。其下缘在T9 - T12水平植入的有25例（67.6%）。术前，左侧肋间动脉平均数量为10±1条，右侧为10±2条（P = 0.59）。术后，左侧开放节段动脉平均数量为3±2条，右侧为4±1条（P = 0.003）。
冰冻象鼻手术与大多数（三分之二）肋间动脉闭塞有关。维持锁骨下动脉和髂动脉的充足血流是取得良好预后的一个不可或缺的前提条件。支架型人工血管远端边缘的置入水平不起决定性作用。
