Gottardi Roman, Voetsch Andreas, Krombholz-Reindl Philip, Winkler Andreas, Steindl Johannes, Dinges Christian, Kirnbauer Michael, Neuner Matthias, Berger Tim, Seitelberger Rainald
Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University Salzburg, Salzburg, Austria.
Department of Anesthesia and Intensive Care, Paracelsus Medical University Salzburg, Salzburg, Austria.
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):669-675. doi: 10.1093/ejcts/ezz234.
The aim of the study was to compare the conventional frozen elephant trunk implantation technique with a modified implantation technique with an aortic anastomosis in zone 1 and extra-anatomic revascularization of the left subclavian artery during reperfusion.
Between May 2014 and March 2018, 40 patients (26 male; mean age 60.2 ± 11.2 years) underwent complete aortic arch replacement with the Thoraflex Hybrid prosthesis™ (Vascutek, Inchinnan, Scotland) at our institution. Seventeen patients underwent conventional arch replacement (group 1) and 23 patients the modified procedure (group 2). Indication for arch replacement included all types of acute and chronic diseases.
Cardiopulmonary bypass time (213.1 ± 53.5 vs 243.8 ± 67.0 min, P = 0.13) and aortic cross-clamp time (114.4 ± 40.7 vs 117.3 ± 56.6 min, P = 0.86) did not differ significantly between group 1 and 2. There was a trend towards a shorter circulatory arrest time (50.72 ± 9.6 vs 44.7 ± 15.5 min; P = 0.20) in group 2. Perioperative mortality was 10% (5.9% vs 13%; P = 0.62). Stroke occurred in 10% (5.9% vs 13%; P = 0.62) of patients. Spinal cord injury occurred in 7.5% of patients (11.8% vs 4.3% P = 0.57). Due to the a proximal aortic anastomosis, there was a significantly shorter coverage of the descending aorta with the prosthesis ending at vertebral level Th7.5 (6.75-8) in group 1 versus Th6.0 (5.0-6.0) in group 2 (P-value = 0.004).
Implantation of the frozen elephant trunk prosthesis in zone 1 allows for a more proximal aortic anastomosis that could make the procedure more feasible especially in patients with difficult anatomies or in an acute setting.
本研究旨在比较传统的冰冻象鼻植入技术与一种改良植入技术，后者在再灌注期间于1区进行主动脉吻合并对左锁骨下动脉进行解剖外血管重建。
2014年5月至2018年3月期间，40例患者（26例男性；平均年龄60.2±11.2岁）在我院接受了使用Thoraflex Hybrid人工血管（Vascutek，因钦南，苏格兰）进行的全主动脉弓置换术。17例患者接受传统的弓部置换术（1组），23例患者接受改良手术（2组）。弓部置换的适应症包括所有类型的急性和慢性疾病。
1组和2组之间的体外循环时间（213.1±53.5 vs 243.8±67.0分钟，P = 0.13）和主动脉阻断时间（114.4±40.7 vs 117.3±56.6分钟，P = 0.86）无显著差异。2组有循环阻断时间缩短的趋势（50.72±9.6 vs 44.7±15.5分钟；P = 0.20）。围手术期死亡率为10%（5.9% vs 13%；P = 0.62）。10%的患者发生中风（5.9% vs 13%；P = 0.62）。7.5%的患者发生脊髓损伤（11.8% vs 4.3%，P = 0.57）。由于近端主动脉吻合，1组人工血管对降主动脉的覆盖明显更短，人工血管末端位于胸7.5椎体水平（6.75 - 8），而2组为胸6.0椎体水平（5.0 - 6.0）（P值 = 0.004）。
在1区植入冰冻象鼻人工血管可实现更近端的主动脉吻合，这可能使该手术更可行，尤其是在解剖结构复杂的患者或急性情况下。
