Chen Su-Wei, Zhong Yong-Liang, Qiao Zhi-Yu, Li Cheng-Nan, Ge Yi-Peng, Qi Rui-Dong, Hu Hai-Ou, Sun Li-Zhong, Zhu Jun-Ming
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
J Thorac Dis. 2020 Dec;12(12):7117-7126. doi: 10.21037/jtd-20-2338.
This study analyzes the outcomes of a one-stage hybrid procedure combining thoracic endovascular aortic repair (TEVAR) with extra-anatomic bypass in patients with distal aortic arch disease.
This retrospective study collected 103 hybrid procedures combining TEVAR with extra-anatomic bypass (mean age, 62.2±9.3 years; 90 males) performed from January 2009 to January 2019 at Beijing Anzhen Hospital. We analyzed 30-day and mid-term outcomes including survival rate and the incidence of stroke, spinal cord injury (SCI), and endoleak.
Five deaths (4.6%) occurred within 30 days, including type I endoleak in Zone 1 (n=1), hemorrhagic shock (n=1), stroke (n=2), and stent migration (n=1). Two patients developed SCI. The median follow-up time was 39.5 (interquartile range, 13.6-69.0) months. In all, 14 late deaths occurred; these were due to stroke (n=2), severe pneumonia (n=1), aortic rupture caused by type I endoleak (n=3), and sudden death (n=8). Six late endoleaks occurred including three type I and one type II in Zone 1 and two type I in Zone 2. In a competing risks analysis, the incidences of reintervention at 7 years, late death, and survival without reintervention were 8%, 22%, and 70%, respectively. In a Cox risk model, stroke (HR, 21.602; 95% CI: 2.798-166.796; P=0.003) was the only risk factor for 30-day mortality. Stroke (HR, 19.484; 95% CI: 5.245-72.380; P<0.001), SCI (HR, 15.548; 95% CI: 2.754-87.786; P=0.002), and endoleak (HR, 4.626; 95% CI: 1.068-20.040; P=0.041) were independent risk factors for long-term mortality.
The one-stage hybrid procedure provides acceptable mid-term results with good mid-term patency of extra-anatomic bypass. Strict selection of patients suitable for hybrid repair can effectively improve the survival rate and reduce the incidence of complications. At the same time, close follow-up patients should receive close long-term follow-up after hybrid procedure.
本研究分析了一期杂交手术治疗主动脉弓远端疾病患者的疗效，该手术将胸主动脉腔内修复术（TEVAR）与解剖外旁路手术相结合。
本回顾性研究收集了2009年1月至2019年1月在北京安贞医院进行的103例TEVAR与解剖外旁路手术相结合的杂交手术（平均年龄62.2±9.3岁；男性90例）。我们分析了30天和中期结果，包括生存率、中风、脊髓损伤（SCI）和内漏的发生率。
30天内发生5例死亡（4.6%），包括1区I型内漏（n=1）、失血性休克（n=1）、中风（n=2）和支架移位（n=1）。2例患者发生SCI。中位随访时间为39.5（四分位间距，13.6 - 69.0）个月。总共发生14例晚期死亡；原因包括中风（n=2）、重症肺炎（n=1）、I型内漏导致的主动脉破裂（n=3）和猝死（n=8）。发生6例晚期内漏，包括1区3例I型和1例II型以及2区2例I型。在竞争风险分析中，7年再次干预、晚期死亡和无再次干预生存的发生率分别为8%、22%和70%。在Cox风险模型中，中风（HR，21.602；95%CI：2.798 - 166.796；P=0.003）是30天死亡率的唯一危险因素。中风（HR，19.484；95%CI：5.245 - 72.380；P<0.001）、SCI（HR，15.548；95%CI：2.754 - 87.786；P=0.002）和内漏（HR，4.626；95%CI：1.068 - 20.040；P=0.041）是长期死亡率的独立危险因素。
一期杂交手术提供了可接受的中期结果，解剖外旁路具有良好的中期通畅率。严格选择适合杂交修复的患者可有效提高生存率并降低并发症发生率。同时，杂交手术后患者应接受密切的长期随访。
