Cardiac Surgery Unit, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Department of Cardiothoracic Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Semin Thorac Cardiovasc Surg. 2019;31(4):686-690. doi: 10.1053/j.semtcvs.2019.03.010. Epub 2019 Apr 10.
Diseases of the thoracic aorta are increasing in prevalence worldwide. Recent data indicated wide regional variation in the volume and complexity of aortic cases undertaken in United Kingdom cardiac centers, especially in case of acute type A aortic dissection (ATAAD) conditions. Patients treated in high-volume centers with a specific multidisciplinary aortic program had a significant reduction in ATAAD mortality when compared with low-volume centers. Following the initial phase of a national aortic center reorganization, the current study reflects the initial experience of a national collective of cardiothoracic surgeons with expertise in complex aortic surgery, using frozen elephant trunk as standard technique for the surgical treatment of patients affected by ATAAD. Between June 2013 and October 2017, 66 ATAAD patients (45% women) underwent hybrid aortic arch and frozen elephant trunk repair with the Thoraflex hybrid graft at 8 UK high-volume aortic centers. The in-hospital mortality accounted for 8 patients (12%). Postoperative temporary or permanent neurologic events and temporary renal replacement therapy occurred in 17% and 20% of patients, respectively. No spinal cord injury events were documented. Our data were similar to those reported in literature in the 2 largest experiences with the use of frozen elephant technique in ATAAD condition (in-hospital/30-day mortality: 11-12%). This initial experience demonstrated that frozen elephant technique can potentially be adopted as standard approach in life-threatening aortic diseases, with acceptable complication and mortality rates.
全球范围内，胸主动脉疾病的患病率正在上升。最近的数据表明，英国心脏中心开展的主动脉病例数量和复杂性存在广泛的区域性差异，尤其是在急性 A 型主动脉夹层（ATAAD）情况下。在高容量中心接受特定多学科主动脉计划治疗的患者，其 ATAAD 死亡率与低容量中心相比显著降低。在国家主动脉中心重组的初始阶段之后，本研究反映了具有复杂主动脉手术专业知识的心胸外科医生的全国性集体的初步经验，使用冷冻象鼻作为 ATAAD 患者手术治疗的标准技术。2013 年 6 月至 2017 年 10 月，8 个英国高容量主动脉中心的 66 名 ATAAD 患者（45%为女性）接受了杂交主动脉弓和冷冻象鼻修复术，使用 Thoraflex 杂交移植物。院内死亡率为 8 例（12%）。术后出现暂时性或永久性神经事件和暂时性肾脏替代治疗的患者分别占 17%和 20%。无脊髓损伤事件记录。我们的数据与使用冷冻象鼻技术治疗 ATAAD 条件下的最大两项经验报告中的数据相似（院内/30 天死亡率：11-12%）。这一初步经验表明，冷冻象鼻技术可能被采用为危及生命的主动脉疾病的标准治疗方法，具有可接受的并发症和死亡率。
