Division of Vascular Surgery, "Vita - Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
Division of Vascular Surgery, "Vita - Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
Ann Thorac Surg. 2019 Nov;108(5):1345-1353. doi: 10.1016/j.athoracsur.2019.04.010. Epub 2019 May 10.
To evaluate the outcomes of frozen elephant trunk (FET) procedures performed with a customized graft that allows debranch-first technique with continuous antegrade cerebral perfusion and early distal aortic and myocardial reperfusion.
Between 2016 and 2018 34 patients (30 men; median age, 59.7 years) were enrolled in an ambispective single-center study called FET Optimization (clinicaltrials.gov: NCT03600077). The patients underwent FET procedure using a novel modified E-Vita graft (JOTEC GmbH, Hechingen, Germany) plus graft with 2 dedicated reperfusion branches with debranch-first technique. Mortality and morbidity were primary endpoints. Secondary endpoints were overall duration of cardiopulmonary bypass, debranching, limb ischemia, cardiac ischemia, cerebral perfusion, and amount of aortic coverage.
No deaths at 30 days were recorded, and the major adverse event (grade ≥ 2) rate was 33% (11 patients) including 1 (3%) nondisabling stroke and 1 (2.9%) permanent spinal cord ischemic event. Proximal FET collar anastomosis were in zone 0 (68%) or zone 1 (32%). Median cardiopulmonary bypass duration was 165 minutes (range, 144-185), distal aortic ischemic time 38 minutes (range, 32-45), and cardiac ischemic time 74 minutes (range, 62-94). The time of distal aortic ischemia was shorter in nonobese patients (27 vs 49 minutes, P = .043) and in zone 0 (23 cases) vs zone 1 (11 cases) anastomosis (34 vs 42 minutes, P = .043).
The FET procedure with debranch-first technique is safe and feasible and resulted in low mortality and morbidity rates. Further investigation is needed to compare it with standard techniques.
评估使用定制移植物进行的冷冻象鼻（FET）手术的结果，该移植物允许使用分支优先技术进行连续顺行脑灌注和早期远端主动脉和心肌再灌注。
在 2016 年至 2018 年间，34 名患者（30 名男性；中位年龄 59.7 岁）参加了一项名为 FET 优化的前瞻性单中心研究（clinicaltrials.gov：NCT03600077）。患者使用新型改良 E-Vita 移植物（JOTEC GmbH，德国海兴根）加带有分支优先技术的 2 个专用再灌注分支的移植物进行 FET 手术。死亡率和发病率是主要终点。次要终点是体外循环的总持续时间、分支切除术、肢体缺血、心脏缺血、脑灌注和主动脉覆盖量。
30 天内未记录到死亡，主要不良事件（≥2 级）发生率为 33%（11 例），包括 1 例（3%）非致残性中风和 1 例（2.9%）永久性脊髓缺血事件。近端 FET 领圈吻合位于 0 区（68%）或 1 区（32%）。体外循环持续时间中位数为 165 分钟（范围，144-185），远端主动脉缺血时间为 38 分钟（范围，32-45），心脏缺血时间为 74 分钟（范围，62-94）。非肥胖患者的远端主动脉缺血时间较短（27 分钟与 49 分钟，P=.043），0 区（23 例）吻合与 1 区（11 例）吻合（34 分钟与 42 分钟，P=.043）。
分支优先技术的 FET 手术是安全可行的，死亡率和发病率低。需要进一步研究来比较它与标准技术。
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