Hsu Hung-Lung, Huang Chun-Yang, Chen Po-Lin, Chen Yin-Yin, Hsu Chiao-Po, Chen I-Ming, Shih Chun-Che
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Heart Vessels. 2019 Sep;34(9):1524-1532. doi: 10.1007/s00380-019-01384-3. Epub 2019 Mar 25.
Banding of the ascending aorta has been introduced as a less complex procedure to optimize the proximal landing zone of the stent graft in hybrid aortic arch surgery. However, data about the long-term results and effects of this technique are still limited. We aimed to study the efficacy of banding of the ascending aorta in hybrid aortic arch repair. The study included 11 high-risk patients with dilated ascending aorta (wider than 38 mm in diameter) undergoing ascending aortic banding for hybrid arch repair. Clinical outcomes, including technical success, endoleaks, perioperative mortality and morbidity, and sequential remodeling of the ascending aorta were investigated. The average diameter of the ascending aorta had been reduced (p = 0.02) from 42.1 mm (range = 39.0-46.4) to 37.2 mm (range = 35.6-38.6) after banding procedure. The technical success rate was 100.0%. No type I endoleak occurred, but 2 cases of distal stent graft-induced new entry required re-interventions. The 5-year survival and freedom from aortic events rates both were 81.8%. The ascending aortic diameter remained stable and no proximal migration of the stent graft was observed during the study period. The 5-year results validated the durability of this therapeutic modality, especially in high-risk patients.
升主动脉缩窄术已被引入，作为一种复杂性较低的手术，用于在杂交主动脉弓手术中优化支架移植物的近端锚定区。然而，关于该技术长期结果和影响的数据仍然有限。我们旨在研究升主动脉缩窄术在杂交主动脉弓修复中的疗效。该研究纳入了11例患有扩张性升主动脉（直径大于38mm）的高危患者，他们接受了升主动脉缩窄术以进行杂交主动脉弓修复。研究了临床结果，包括技术成功率、内漏、围手术期死亡率和发病率，以及升主动脉的序贯重塑情况。缩窄术后升主动脉的平均直径从42.1mm（范围为39.0 - 46.4）降至37.2mm（范围为35.6 - 38.6）（p = 0.02）。技术成功率为100.0%。未发生I型内漏，但有2例远端支架移植物引起的新破口需要再次干预。5年生存率和无主动脉事件发生率均为81.8%。在研究期间，升主动脉直径保持稳定，未观察到支架移植物近端移位。5年的结果证实了这种治疗方式的耐久性，尤其是在高危患者中。
