Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Cardiothoracic Surgery, Chongqing Medical Emergency Center, Chongqing, 400014, China.
J Cardiothorac Surg. 2020 Sep 29;15(1):282. doi: 10.1186/s13019-020-01341-6.
Open stented elephant trunk (SET) or SET with left subclavian artery (LSCA) to left common carotid artery (LCCA) bypass is proven to a potentially alternative treatment for complicated Stanford type B aortic dissection (TBAD). In the current study, we reported our experience with ten consecutive TBAD patients who underwent open SET.
Patients with complicated TBAD underwent open SET from May 2016 to November 2018 in our institution were included. Patients' clinical data were obtained from the electronic medical record system, and long-term clinical outcomes were collected by telephone interviews or outpatient interviews.
A total of ten patients with nine males and one female were included, and the average age was 47.3 (31-65) years. Increased D-dimer and fibrinogen degradation products were observed in all patients at admission, and two patients had renal insufficiency. The average postoperative mechanical ventilation time, length of stay in intensive care unit, and postoperative hospital length of stay were 46.9 (6.7-151.2) hours, 7.7 (4-17) days, and 15.7 (10-26) days. No postoperative death occurred. Acute kidney injury and other complications were observed, and they were recovered well when discharge. In long-term follow-up, computed tomography angiography indicated that aortas were completely well remodeled, and blood supply of the brachiocephalic trunks was normal without anastomotic complications. All patients lived well.
SET or SET with subclavian artery correction shows satisfactory clinical outcomes, and it could be considered as an alternative treatment. Well-designed, large-scale studies with long-term follow-up are still needed.
开放支架象鼻术（SET）或 SET 联合左锁骨下动脉（LSCA）至左颈总动脉（LCCA）旁路术已被证实是治疗复杂 Stanford B 型主动脉夹层（TBAD）的一种潜在替代治疗方法。在本研究中，我们报告了连续 10 例接受开放 SET 的 TBAD 患者的经验。
本研究纳入了 2016 年 5 月至 2018 年 11 月在我院接受开放 SET 的复杂 TBAD 患者。从电子病历系统中获取患者的临床资料，并通过电话或门诊访谈收集长期临床结果。
共纳入 10 例患者，其中 9 例为男性，1 例为女性，平均年龄为 47.3（31-65）岁。所有患者入院时均存在 D-二聚体和纤维蛋白原降解产物升高，2 例存在肾功能不全。术后机械通气时间、重症监护病房住院时间和术后住院时间的平均值分别为 46.9（6.7-151.2）小时、7.7（4-17）天和 15.7（10-26）天。术后无死亡病例发生。出现急性肾损伤等并发症，但出院时均恢复良好。长期随访中，CT 血管造影显示主动脉完全重塑，头臂干血供正常，无吻合口并发症。所有患者均存活良好。
SET 或 SET 联合锁骨下动脉矫正术具有满意的临床效果，可作为一种替代治疗方法。仍需要设计良好、长期随访的大规模研究。
