Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Interact Cardiovasc Thorac Surg. 2020 Sep 1;31(3):346-353. doi: 10.1093/icvts/ivaa124.
Our goal was to investigate the surgical strategy for type Ia endoleak after thoracic endovascular aortic repair (TEVAR) by reporting our experiences.
From November 2012 to September 2019, a total of 23 patients received surgical management for type Ia endoleak after TEVAR.
The operations included total arch replacement with the frozen elephant trunk technique in 15 patients, direct closure of the endoleak in 2 patients, hybrid aortic arch repair in 4 patients, arch debranching with TEVAR in 1 patient and left common carotid artery to left subclavian artery bypass with TEVAR in 1 patient. Among 21 patients with cardiopulmonary bypass (CPB), the mean CPB and aortic cross-clamp times were 146.7 ± 42.2 and 81.0 ± 43.3 min, respectively. The selective cerebral perfusion time was 18.8 ± 8.2 min in 17 patients with hypothermic circulatory arrest. The in-hospital mortality was 8.7% (2/23). Type Ia endoleak was sealed successfully after surgery in 95.5% (21/22) of patients. The follow-up data were available for all 21 survivors. The median follow-up period was 18 months (range 1-84 months). During the follow-up period, a total of 8 patients died or had aortic events, including 5 deaths and 6 aortic events.
Different surgical strategies could be selected to treat patients with type Ia endoleak after TEVAR, with acceptable early and late outcomes.
通过报告我们的经验，探讨胸主动脉腔内修复术（TEVAR）后ⅠA型内漏的手术策略。
2012 年 11 月至 2019 年 9 月，共有 23 例患者因 TEVAR 后ⅠA型内漏接受手术治疗。
15 例患者接受全弓置换加冷冻象鼻技术，2 例患者直接关闭内漏，4 例患者行杂交主动脉弓修复，1 例患者行弓分支阻断加 TEVAR，1 例患者行左颈总动脉至左锁骨下动脉旁路加 TEVAR。21 例患者在体外循环（CPB）下进行手术，CPB 和主动脉阻断时间分别为 146.7±42.2 和 81.0±43.3 分钟。17 例患者行低温停循环，选择性脑灌注时间为 18.8±8.2 分钟。住院死亡率为 8.7%（2/23）。22 例患者中 21 例（95.5%）术后ⅠA型内漏成功封闭。21 例幸存者均获得随访资料。中位随访时间为 18 个月（1~84 个月）。随访期间，共 8 例患者死亡或发生主动脉事件，包括 5 例死亡和 6 例主动脉事件。
TEVAR 后ⅠA型内漏可选择不同的手术策略进行治疗，早期和晚期结果可接受。
