Gaudry Marine, Porto Alizée, Blanchard Arnaud, Chazot Jean-Victor, Bal Laurence, De Masi Mariangela, Bartoli Axel, Barral Pierre-Antoine, Jacquier Alexis, Gariboldi Vlad, Collart Fréderic, Deplano Valérie, Piquet Philippe
Department of Vascular Surgery, Timone Hospital, APHM, 13005, Marseille, France.
Timone Aortic Center, Timone Hospital, APHM, 13005, Marseille, France.
Cardiovasc Drugs Ther. 2022 Apr;36(2):285-294. doi: 10.1007/s10557-021-07150-w. Epub 2021 Feb 2.
Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair.
In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture.
Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29).
In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.
对于慢性主动脉夹层（RAD）患者，杂交主动脉弓修复术是一种比传统手术治疗侵入性更小的替代方案。本研究的目的是描述A型修复术后杂交治疗RAD的短期和长期结果。
在这项回顾性单中心队列研究中，纳入了所有接受杂交主动脉弓修复术治疗慢性RAD的患者。治疗指征为主动脉快速生长、主动脉直径>55mm或主动脉破裂。
2009年至2020年期间，我们对慢性RAD进行了29次杂交治疗。24例患者在0区和5区进行了完全主动脉弓上分支去分支，仅在2区进行了左锁骨下动脉去分支。围手术期死亡1例（3.4%）：该患者因主动脉破裂接受治疗。无脊髓缺血，1例轻度卒中（3.4%）。中位随访25.4个月（范围3 - 97个月）后，长期死亡率为10.3%（3/29），无晚期主动脉相关死亡。27例患者（93.1%）发生降主动脉FL血栓形成；胸腹主动脉瘤进展率为41.4%（12/29），主动脉再次干预率为34.5%（10/29）。
在一个大容量主动脉中心，RAD的杂交修复术具有良好的解剖学结果，围手术期发病率和死亡率风险较低，包括在0区治疗的患者。有时需要再次置换升主动脉段，以提供更安全的近端锚定区并降低TEVAR术后Ⅰ型内漏的风险。
