Yamane Yoshitaka, Katayama Keijiro, Furukawa Tomokuni, Shimizu Haruna, Okazaki Takanobu, Takasaki Taiichi, Kurosaki Tatsuya, Takahashi Shinya
Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan.
Cardiovascular Center, Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan.
Ann Vasc Dis. 2020 Jun 25;13(2):137-143. doi: 10.3400/avd.oa.19-00131.
: In this study, we report our experience using the frozen elephant trunk (FET) technique for chronic aortic dissection. : Between January 2011 and December 2017, 15 patients underwent total arch replacement (TAR) with the FET technique for chronic aortic dissection (CAD). : Hospital mortality was 6.7% (n=1). No patients experienced spinal cord injury. Distal stent-induced new entry (dSINE) occurred in the early postoperative period in one patient. There were four unplanned additional operations to manage dSINE. Five patients suffered from dSINE, and aortoesophageal fistula developed in three of them. Short insertion length of the FET and large angle between the distal edge of the FET and the descending aorta were significantly more common in the dSINE group than in the non-dSINE group. The cumulative survival rates at 1, 3, and 5 years were 93.3%, 93.3%, and 66.4%, respectively. The cumulative aortic event-free rates at 1, 2, and 3 years were 85.7%, 77.1%, and 52.9%, respectively. : The FET technique for CAD provided good early results. Short insertion length of the FET, however, can induce dSINE, which requires an additional operation at mid-term. Thus, surgical indication of the FET technique for CAD must be discussed.
在本研究中,我们报告了使用冰冻象鼻(FET)技术治疗慢性主动脉夹层的经验。2011年1月至2017年12月期间,15例患者接受了采用FET技术的全主动脉弓置换术(TAR)治疗慢性主动脉夹层(CAD)。医院死亡率为6.7%(n = 1)。无患者发生脊髓损伤。1例患者在术后早期出现远端支架诱导的新破口(dSINE)。有4例为处理dSINE而进行的非计划追加手术。5例患者发生dSINE,其中3例发生主动脉食管瘘。dSINE组FET插入长度短以及FET远端边缘与降主动脉之间夹角大的情况明显比非dSINE组更常见。1年、3年和5年的累积生存率分别为93.3%、93.3%和66.4%。1年、2年和3年的累积无主动脉事件发生率分别为85.7%、77.1%和52.9%。FET技术治疗CAD取得了良好的早期效果。然而,FET插入长度短可诱发dSINE,这需要在中期进行追加手术。因此,必须对FET技术治疗CAD的手术指征进行讨论。