胸主动脉腔内修复术中烟囱技术治疗急性 A 型主动脉夹层

Elephant Trunk Stent Fenestration for Acute Type A Aortic Dissection.

机构信息

Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Hubei, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Hubei, China; Central Laboratory, Renmin Hospital of Wuhan University, Hubei, China.

出版信息

Ann Thorac Surg. 2021 Sep;112(3):747-754. doi: 10.1016/j.athoracsur.2020.12.018. Epub 2020 Dec 29.

DOI:10.1016/j.athoracsur.2020.12.018

PMID:33385366

Abstract

BACKGROUND

This study investigated the clinical outcomes of elephant trunk stent fenestration in patients with acute type A aortic dissection (ATAAD).

METHODS

From January 2009 to December 2019, 271 ATAAD patients were treated in the Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University. Patients underwent deep hypothermia circulatory arrest with bilateral antegrade cerebral perfusion with total arch replacement and elephant trunk stent fenestration. Patient characteristics, perioperative findings, and follow-up results were analyzed retrospectively.

RESULTS

The average in-hospital mortality rate was 4.1%, the cardiopulmonary bypass time was 160.8 ± 60.4 minutes, the cross-clamp time was 91.1 ± 24.5 minutes, and the circulatory arrest time was 22.8 ± 5.5 minutes. The rate of reoperation for bleeding was 1.5%, and the pericardial mediastinal drainage volume was 312.0 ± 159.2 mL 24 hours after surgery. Follow-up data were available for 95.4% of patients. Endoleaks developed in 2 patients 3 years after surgery. The postoperative survival rate was 93.0% at 1 year, 89.3% at 5 years, and 81.7% at 10 years.

CONCLUSIONS

Elephant trunk stent fenestration can simplify reconstruction of the left subclavian artery in ATAAD patients and reduce surgical difficulty. Because the early postoperative outcomes and long-term results were satisfactory in our sample, this technique should be promoted for some patients with ATAAD.

摘要

背景

本研究探讨了在急性 A 型主动脉夹层（ATAAD）患者中使用象鼻支架开窗术的临床效果。

方法

自 2009 年 1 月至 2019 年 12 月，武汉大学人民医院心血管外科共收治 271 例 ATAAD 患者。患者均接受深低温停循环双侧顺行脑灌注全主动脉弓置换联合象鼻支架开窗术治疗。回顾性分析患者的一般资料、围术期情况及随访结果。

结果

平均住院死亡率为 4.1%，体外循环时间为 160.8±60.4 分钟，主动脉阻断时间为 91.1±24.5 分钟，停循环时间为 22.8±5.5 分钟。再次开胸止血率为 1.5%，术后 24 小时心包纵隔引流总量为 312.0±159.2ml。95.4%的患者获得随访资料。术后 3 年 2 例患者发生内漏。术后 1 年、5 年和 10 年的生存率分别为 93.0%、89.3%和 81.7%。