Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.
Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany.
Eur J Cardiothorac Surg. 2021 Apr 29;59(4):741-749. doi: 10.1093/ejcts/ezaa383.
The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD).
This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1).
Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients.
Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
本文旨在报告使用定制器械（CMD）进行升主动脉血管腔内修复的中期结果。
这是一项在三级中心进行的回顾性研究。9 名被认为不适合开放手术的患者接受了升主动脉全血管腔内修复的选择性治疗，使用的器械是 Relay®（Terumo Aortic，Sunrise；FL，美国）CMD：假性动脉瘤（n=5）、局限性夹层（n=3）和破裂（n=1）。
所有患者均获得了主要临床成功，无重大并发症，无早期转为开放手术。所有患者均出院回家并独立生活：中位住院时间为 7 天（四分位间距，6-18）。在中位 26 个月（四分位间距，12-36）的随访中，没有患者失访。3 名患者在介入后 2、6 和 24 个月死亡；1 例与主动脉相关（由于感染导致晚期主动脉-心房瘘，需要开放手术）。在可获得的最后一次随访中，其余 6 名患者均未观察到内漏、迁移、骨折或破裂。
在非常选择的病变中，使用 Terumo Aortic CMD 进行升主动脉血管腔内修复在技术上是可行、有效和安全的。CMD 对不同的结构和直径的升主动脉具有良好的顺应性，中期结构完整性和主动脉病变排除显示出令人满意的耐久性。
