Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
Department of Cardiac Surgery, MedStar Heart and Vascular Institute/Georgetown University School of Medicine, Washington, DC.
Thorac Cardiovasc Surg. 2021 Jun;69(4):336-344. doi: 10.1055/s-0040-1713354. Epub 2020 Jul 7.
The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education.
Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A).
Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups.
The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.
本研究旨在验证使用新型冷冻象鼻装置进行全主动脉弓置换术（TAR）的安全性，该装置由受训者作为外科教育操作。
回顾性分析 2014 年 4 月至 2019 年 3 月期间我院收治的 64 例急性主动脉夹层 A 型（AADA）患者，其中 19 例（29.6%）接受 TAR。29 例由受训者（T 组）操作，35 例由主治医生（A 组）操作。
两组患者特征无差异。T 组手术时间（409.4 ± 87.8 分钟 vs. 468.6 ± 129.6 分钟， = 0.034）、体外循环时间（177.7 ± 50.4 分钟 vs. 222.9 ± 596.7 分钟， = 0.019）和低温循环阻断时间（39.5 ± 13.4 分钟 vs. 54.5 ± 18.5 分钟， = 0.001）均明显短于 A 组，但主动脉夹闭时间无差异（115.3 ± 55.7 分钟 vs. 114.2 ± 35.0 分钟， = 0.924），因为 A 组同时进行手术的比例更高（37.1% vs. 10.3%， = 0.014）。全队列 30 天死亡率为 3.1%。尽管 T 组手术时间较长，但两组术后结果无显著差异，主刀医生的经验水平不是院内死亡 + 主要术后并发症的独立预测因素。两组间晚期死亡和主动脉事件无差异。
本研究表明，TAR 可由受训者安全进行，提示 TAR 是一种可行且安全的教育操作。
