Tsagakis Konstantinos, Pacini Davide, Grabenwöger Martin, Borger Michael A, Goebel Nora, Hemmer Wolfgang, Laranjeira Santos Alvaro, Sioris Thanos, Widenka Kazimierz, Risteski Petar, Mascaro Jorge, Rudez Igor, Zierer Andreas, Mestres Carlos A, Ruhparwar Arjang, Di Bartolomeo Roberto, Jakob Heinz
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany.
Department of Cardiac Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Ann Cardiothorac Surg. 2020 May;9(3):178-188. doi: 10.21037/acs-2020-fet-25.
Over the years, frozen elephant trunk (FET) has become the treatment of choice for multisegmental thoracic aortic disease. This multicenter study presents the evolution of FET results using the E-vita Open hybrid graft with respect to institutional experience and time.
The data of International E-vita Open registry were studied according to the institutional experience of the participating centers (high- versus low-volume centers) and according to the evolution of FET treatment during time (1 period, 2005-2011 versus 2 period, 2012-2018). Overall, 1,165 patients were enrolled in the study with a wide variety of multisegmental thoracic aortic pathologies and aortic emergencies. Participating centers determined their own surgical protocol.
The overall 30-day mortality was 12%. Short- and long-term survival were higher in high- versus low-volume centers (P=0.048 and P=0.013, respectively). In the 2 time period, cerebral complications were reduced significantly (P=0.015). Incidence of permanent spinal cord-related symptoms was reduced to 3% in the 2 time period, but did not reach statistical significance. Hypothermic circulatory arrest time (P<0.001) and incidence of postoperative temporary renal replacement therapy (P=0.008) were significantly reduced in the 2 time period. Ten-year survival and freedom from aortic-related death rates were 46.6% and 85.7%, respectively, for the entire group. The freedom from distal aortic re-interventions for a new or progressive residual aortic disease was 76.0%.
Evolution of FET arch repair techniques with the E-vita Open graft and increasing institutional experience were associated with improved results. Progression of residual aortic disease makes close follow-up with aortic imaging mandatory in such patients.
多年来，冰冻象鼻技术（FET）已成为多节段胸主动脉疾病的首选治疗方法。这项多中心研究展示了使用E-vita Open杂交移植物的FET治疗结果随机构经验和时间的演变情况。
根据参与中心的机构经验（高容量中心与低容量中心）以及FET治疗随时间的演变情况（第1阶段，2005 - 2011年与第2阶段，2012 - 2018年），对国际E-vita Open注册研究的数据进行了分析。总体而言，1165例患有各种多节段胸主动脉病变和主动脉急症的患者纳入了该研究。参与中心自行确定其手术方案。
总体30天死亡率为12%。高容量中心的短期和长期生存率高于低容量中心（分别为P = 0.048和P = 0.013）。在第2时间段，脑部并发症显著减少（P = 0.015）。永久性脊髓相关症状的发生率在第2时间段降至3%，但未达到统计学显著性。低温循环阻断时间（P < 0.001）和术后临时肾脏替代治疗的发生率（P = 0.008）在第2时间段显著降低。整个组的10年生存率和无主动脉相关死亡率分别为46.6%和85.7%。对于新发或进展性残余主动脉疾病，免于远端主动脉再次干预的比例为76.0%。
使用E-vita Open移植物的FET主动脉弓修复技术的发展以及机构经验的增加与更好的治疗结果相关。残余主动脉疾病的进展使得对此类患者必须进行主动脉影像学密切随访。
