Department of Cardiovascular Surgery, S. Orsola Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Department of Cardiothoracic, Transplantation, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Thorac Cardiovasc Surg. 2020 Apr;159(4):1201-1211. doi: 10.1016/j.jtcvs.2019.03.121. Epub 2019 May 11.
We report on a large series of patients treated at the S. Orsola Hospital, University of Bologna (Bologna, Italy) and Hannover Medical School (Hannover, Germany), with the aim to evaluate the early and midterm results.
Between January 2007 and March 2017, 437 patients underwent total aortic arch replacement with the frozen elephant trunk technique. The frozen elephant trunk prostheses used were the custom-made Chavan-Haverich (Hanover, Germany) (n = 27, 6%), Jotec E-vita open (Jotec Inc, Hechingen, Germany) (n = 192, 44%), and Vascutek Thoraflex-Hybrid (Vascutek, Inchinnan, Scotland) (n = 218, 50%). The main indications were thoracic aortic aneurysm (n = 135, 31%), chronic aortic dissection (n = 182, 41.6%), and acute aortic dissection (n = 120, 27.5%).
Overall in-hospital mortality was 14.9%, and permanent neurologic deficit and spinal cord injury were 10.8% and 5.5%, respectively. Patients with chronic aortic dissection presented a better in-hospital mortality rate than the thoracic aortic aneurysm and acute aortic dissection groups. Independent risk factors for mortality in the overall population were prolonged cardiopulmonary bypass time, age, urgent/emergency surgery, and Marfan syndrome. The median (p25, p75) follow-up time was 2.6 (1.4-4.4) years, and the mortality rate was 7.01 (95% confidence interval, 5.7-8.7) per 100 patient-years. A total of 86 patients (23.1%) required an additional procedure during the follow-up; 61 (16.3%) required endovascular extensions, and 25 (6.7%) required aortic surgery.
The frozen elephant trunk technique is a treatment option for all complex pathologies of the thoracic aorta. Patients with thoracic aortic aneurysms presented a higher mortality rate, and in patients with acute aortic dissection, the malperfusion syndrome still remains a catastrophic complication. The midterm follow-up showed satisfactory results in terms of survival and freedom from reintervention.
我们报告了在意大利博洛尼亚大学圣奥尔索拉医院（S. Orsola Hospital，University of Bologna）和德国汉诺威医学院（Hannover Medical School）接受治疗的大量患者的结果，旨在评估早期和中期结果。
2007 年 1 月至 2017 年 3 月，437 例患者接受了全主动脉弓置换术，使用冷冻象鼻技术。使用的冷冻象鼻假体分别为定制的 Chavan-Haverich（德国汉诺威，27%，n=27）、Jotec E-vita open（德国 Jotec Inc，Hechingen，44%，n=192）和 Vascutek Thoraflex-Hybrid（英国 Vascutek，Inchinnan，50%，n=218）。主要适应证为胸主动脉瘤（n=135，31%）、慢性主动脉夹层（n=182，41.6%）和急性主动脉夹层（n=120，27.5%）。
总体院内死亡率为 14.9%，永久性神经功能缺损和脊髓损伤分别为 10.8%和 5.5%。慢性主动脉夹层患者的院内死亡率优于胸主动脉瘤和急性主动脉夹层组。全人群死亡率的独立危险因素包括体外循环时间延长、年龄、紧急/急诊手术和马凡综合征。中位数（25%，75%）随访时间为 2.6（1.4-4.4）年，死亡率为每 100 例患者年 7.01（95%置信区间，5.7-8.7）。随访期间共有 86 例（23.1%）患者需要进行额外的手术；61 例（16.3%）需要进行血管内延伸，25 例（6.7%）需要进行主动脉手术。
冷冻象鼻技术是治疗胸主动脉所有复杂病变的一种选择。胸主动脉瘤患者的死亡率较高，而急性主动脉夹层患者的灌注不良综合征仍然是灾难性的并发症。中期随访结果显示，在生存率和免于再次干预方面均取得了令人满意的结果。
