两例冰冻象鼻主动脉假体治疗急性主动脉夹层的多中心经验†。

Multicentre experience with two frozen elephant trunk prostheses in the treatment of acute aortic dissection†.

机构信息

Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Freiburg, Freiburg, Germany.

Medical Faculty, Albert Ludwigs-University Freiburg, Freiburg, Germany.

出版信息

Eur J Cardiothorac Surg. 2019 Sep 1;56(3):572-578. doi: 10.1093/ejcts/ezz037.

DOI:10.1093/ejcts/ezz037

PMID:30844055

Abstract

OBJECTIVES

The aim of this study was to evaluate early- and mid-term outcome and aortic remodelling in patients undergoing implantation of 2 different frozen elephant trunk prostheses, either the Thoraflex™ hybrid (Vascutek, Inchinnan, UK) and the E-vita Open (Jotec Inc., Hechingen, Germany) for acute aortic dissection.

METHODS

All consecutive patients [n = 88; median age 59 (49-67) years; 69% male] undergoing surgery with a frozen elephant trunk prosthesis for acute aortic dissection from August 2005 until March 2018 were included in this study. The Thoraflex™ device was implanted in 55 patients and the E-vita Open graft in 33 patients.

RESULTS

Preoperative characteristics did not differ significantly between groups. There was also no statistically significant difference in postoperative outcome: in-hospital mortality (11% vs 12%; P > 0.99), stroke (18% vs 6%; P = 0.12) and spinal cord injury (6% vs 6%; P > 0.99). While there was no statistically significant difference in the occurrence of distal stent graft-induced new entries (16% vs 18%; P = 0.77), there was a significantly higher rate of secondary endovascular aortic interventions in the Thoraflex™ hybrid group (22% vs 0%; P = 0.003). There was a trend towards a higher rate of false lumen thrombosis at the level of the stent graft (74% vs 95%; P = 0.085) and was comparable at the thoraco-abdominal transition (53% vs 80%; P = 0.36) 1 year after implantation of the prostheses.

CONCLUSIONS

In this comparison of 2 frozen elephant trunk prostheses, there is no evidence that different surgical techniques influence in-hospital outcome. At 1-year follow-up, patients who underwent implantation of the E-vita Open prosthesis showed a significantly reduced rate of secondary aortic interventions and a trend towards a higher rate of false lumen thrombosis which might be attributed to a longer coverage of the descending aorta due to a longer stent graft design and significantly more frequent implantation in zone 3.

摘要

目的

本研究旨在评估接受两种不同冷冻象鼻移植物植入术的患者的早期和中期结果及主动脉重塑情况，这两种移植物分别是 Thoraflex™ 杂交型（Vascutek， Inchinnan，英国）和 E-vita Open（Jotec Inc.，Hechingen，德国），用于治疗急性主动脉夹层。

方法

本研究纳入了 2005 年 8 月至 2018 年 3 月期间因急性主动脉夹层接受冷冻象鼻移植物手术的连续患者（n=88；中位年龄 59（49-67）岁；69%为男性）。55 例患者植入了 Thoraflex™ 装置，33 例患者植入了 E-vita Open 移植物。

结果

两组患者的术前特征无显著差异。术后结局也无统计学差异：院内死亡率（11%比 12%；P>0.99）、卒中（18%比 6%；P=0.12）和脊髓损伤（6%比 6%；P>0.99）。虽然远端支架移植物诱导的新入口的发生率无统计学差异（16%比 18%；P=0.77），但 Thoraflex™ 杂交型组的二次血管内主动脉介入治疗率明显更高（22%比 0%；P=0.003）。支架移植物水平的假腔血栓形成率呈升高趋势（74%比 95%；P=0.085），而胸腹部移行处的血栓形成率相似（53%比 80%；P=0.36），在植入假体后 1 年。

结论

在两种冷冻象鼻移植物的比较中，没有证据表明不同的手术技术会影响住院期间的结果。在 1 年的随访中，植入 E-vita Open 移植物的患者二次主动脉介入治疗率显著降低，假腔血栓形成率呈升高趋势，这可能归因于支架移植物设计更长，覆盖降主动脉更长，以及 Zone 3 更频繁的植入，导致支架移植物更频繁的植入。