Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Eur J Cardiothorac Surg. 2019 Sep 1;56(3):564-571. doi: 10.1093/ejcts/ezz103.
We compared the results of 2 groups of patients who underwent aortic arch replacement with the frozen elephant trunk technique. In the first group, the distal anastomosis was performed in arch zone 2; in the second control group, the distal anastomosis was performed in arch zone 3.
Between January 2007 and April 2018, the frozen elephant trunk technique was used in 282 patients. The median age was 62 years (range 18-83 years), and 233 patients were men (82.6%). Two different frozen elephant trunk prostheses were used: the Jotec E-vita open prosthesis in 167 patients (59.2%) and the Vascutek Thoraflex hybrid prosthesis in 115 patients (40.8%). Patients were divided into 2 groups according to the distal anastomosis site: zone 2 group (69 patients) and zone 3 group (213 patients). The main indications were chronic aortic dissection (n = 164, 58.2%), degenerative aneurysm (n = 72, 25.5%) and acute aortic dissections (n = 45, 16%).
The overall in-hospital mortality rate was 17%: 20% for the zone 2 group and 16% for the zone 3 group, without significant differences, also in terms of cardiopulmonary bypass and myocardial ischaemia times. However, the visceral ischaemia time was significantly shorter for the zone 2 group, whereas the antegrade selective cerebral perfusion time was significantly longer for the same group. Recurrent laryngeal nerve injury rate was lower in the zone 2 group. The overall postoperative paraplegia rate was 3.5%, whereas the occurrence of permanent neurological dysfunction and dialysis was 9% and 19%, respectively, with no significant differences between the groups.
'Proximalization' of the distal anastomosis can be used for arch reconstruction, especially in complex cases such as reoperations or acute aortic dissections. Furthermore, with the aid of branched hybrid grafts, a reduction of the visceral ischaemia time is achieved.
我们比较了两组接受主动脉弓置换和冷冻象鼻技术的患者的结果。在第一组中，远端吻合在弓区 2 进行；在第二对照组中，远端吻合在弓区 3 进行。
2007 年 1 月至 2018 年 4 月，采用冷冻象鼻技术治疗 282 例患者。中位年龄 62 岁（范围 18-83 岁），233 例为男性（82.6%）。使用了两种不同的冷冻象鼻假体：167 例患者使用 Jotec E-vita 开放式假体（59.2%），115 例患者使用 Vascutek Thoraflex 杂交假体（40.8%）。根据远端吻合部位将患者分为两组：区 2 组（69 例）和区 3 组（213 例）。主要适应证为慢性主动脉夹层（n=164，58.2%）、退行性动脉瘤（n=72，25.5%）和急性主动脉夹层（n=45，16%）。
总的院内死亡率为 17%：区 2 组为 20%，区 3 组为 16%，无显著差异，体外循环和心肌缺血时间也无显著差异。然而，区 2 组的内脏缺血时间明显更短，而同一组的顺行选择性脑灌注时间明显更长。区 2 组喉返神经损伤率较低。总的术后截瘫发生率为 3.5%，永久性神经功能障碍和透析的发生率分别为 9%和 19%，两组之间无显著差异。
“近端化”远端吻合可用于弓部重建，特别是在复杂病例如再次手术或急性主动脉夹层。此外，借助分支杂交移植物，可减少内脏缺血时间。
