Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University Graduate School of Medicine, Fukuoka, Japan.
J Vasc Surg. 2019 Jun;69(6):1719-1725. doi: 10.1016/j.jvs.2018.08.184.
The therapeutic strategy for extended aortic arch aneurysms remains controversial and has changed substantially since thoracic endovascular aortic repair was introduced. We applied single-stage hybrid (s-hybrid) total arch replacement (TAR), which involved ascending aorta replacement and debranching of arch vessels, consecutively performed with thoracic endovascular aortic repair for extended arch aneurysms. The aim of this study was to investigate the short-term results of s-hybrid TAR and to clarify the benefit of this method.
We reviewed the operative results of 62 patients who underwent elective s-hybrid TAR or conventional TAR (c-TAR) through the median approach from 2008 to 2017. We used the s-hybrid approach in 15 patients and the c-TAR approach in 47 patients. In both groups, axillary arterial perfusion and selective antegrade cerebral perfusion under moderate hypothermia were applied for brain protection. We compared the perioperative outcomes of the two groups.
We completed s-hybrid TAR in all 15 patients with extended aneurysms. The s-hybrid group required shorter times for myocardial ischemia, selective antegrade cerebral perfusion, and circulatory arrest of the lower body compared with the c-TAR group. The patients with complicated recurrent laryngeal nerve palsy and long ventilation support times were fewer in the s-hybrid group. No patient had substantial endoleaks or permanent paraplegia. The in-hospital mortality rates were 6.7% in the s-hybrid group and 0% in the c-TAR group.
The s-hybrid TAR has the same or better perioperative outcomes compared with the c-TAR approach. For extended aneurysms, this technique could resolve the problem of respiratory failure induced by left thoracotomy and also resolve the problem of rupture during the waiting period in staged surgery.
自胸主动脉腔内修复术（TEVAR）引入以来，对于扩展主动脉弓动脉瘤的治疗策略仍存在争议，且已发生重大变化。我们采用了一站式杂交（s-hybrid）全主动脉弓置换术（TAR），该术式包括升主动脉置换和弓部血管的分支重建，连续进行 TEVAR 治疗扩展型主动脉弓动脉瘤。本研究旨在探讨 s-hybrid TAR 的短期疗效，并阐明该方法的优势。
我们回顾性分析了 2008 年至 2017 年间采用正中入路行择期 s-hybrid TAR 或传统 TAR（c-TAR）的 62 例患者的手术结果。我们在 15 例患者中采用 s-hybrid 方法，在 47 例患者中采用 c-TAR 方法。两组均采用腋动脉灌注和中度低温下选择性顺行脑灌注进行脑保护。我们比较了两组患者的围手术期结果。
我们成功完成了所有 15 例扩展型动脉瘤患者的 s-hybrid TAR。s-hybrid 组在心肌缺血、选择性顺行脑灌注和下半身循环阻断时间方面均短于 c-TAR 组。s-hybrid 组中并发喉返神经麻痹和长时间通气支持的患者更少。无患者发生明显内漏或永久性截瘫。s-hybrid 组的院内死亡率为 6.7%，c-TAR 组为 0%。
s-hybrid TAR 的围手术期结果与 c-TAR 方法相同或更好。对于扩展型动脉瘤，该技术可以解决左侧开胸引起的呼吸衰竭问题，也可以解决分期手术等待期间破裂的问题。
