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急性和慢性胸主动脉疾病中胸主动脉腔内修复术应用的当前选择与建议:欧洲心脏病学会(ESC)心血管外科工作组、ESC主动脉与外周血管疾病工作组、ESC经皮心血管介入欧洲协会(EAPCI)以及欧洲心胸外科学会(EACTS)的专家共识文件

Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS).

作者信息

Czerny Martin, Pacini Davide, Aboyans Victor, Al-Attar Nawwar, Eggebrecht Holger, Evangelista Arturo, Grabenwöger Martin, Stabile Eugenio, Kolowca Maciej, Lescan Mario, Micari Antonio, Muneretto Claudio, Nienaber Christoph, de Paulis Ruggero, Tsagakis Konstantinos, Rylski Bartosz, Braverman Alan C, Di Marco Luca, Eagle Kim, Falk Volkmar, Gottardi Roman

机构信息

University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany.

Policlinico S.Orsola-Malpighi, Bologna, Italy.

出版信息

Eur J Cardiothorac Surg. 2021 Jan 4;59(1):65-73. doi: 10.1093/ejcts/ezaa268.

Abstract

Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of-in analogy to the heart team-aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta-the aortic root, in particular in acute type A aortic dissection-which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.

摘要

自20世纪90年代末临床应用以来,胸主动脉腔内修复术(TEVAR)已成为治疗多种胸主动脉急慢性疾病的标准方法。虽然TEVAR已被许多人接受,但这项颠覆性技术也推动了开放手术的持续发展,随着TEVAR晚期失败确实需要开放手术矫正,这使得将两种治疗选择统一在一个框架下变得更加重要。这一事实表明,类似于心脏团队,主动脉中心的形成和护理的集中化非常重要,它能刺激持续发展并改善治疗结果。接下来要探索的前沿领域是主动脉最近端的部分——主动脉根部,尤其是在急性A型主动脉夹层中,这在未来几年仍将是主要挑战。本文的目的是向读者提供关于在急慢性胸主动脉疾病中使用或不使用TEVAR的当前证据概述,分享关于修改术语和报告标准的最新建议,并最终展望未来的发展。

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