Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1227-1235. doi: 10.1093/ejcts/ezab016.
Thoracic endovascular aortic repair (TEVAR) has been gradually extended to the aortic arch region, with improved results. However, the rates of strokes and endoleaks in a hybrid TEVAR remain high. The goal of this study was to clarify the effectiveness of a hybrid TEVAR with a zone 0 landing using our treatment strategy.
From April 2008 to March 2020, a total of 102 patients were enrolled in this study, with a median follow-up period of 3.2 years. The procedures included total debranching TEVAR with graft replacement of the ascending aorta in 62 patients, total debranching TEVAR with ascending aorta banding in 19 patients and total debranching TEVAR without ascending aorta banding in 21 patients.
Thirty-day mortality and hospital deaths were 1.0% (n = 1) and 3.9% (n = 4), respectively. The rates of aortic complications and endoleaks during the first 30 days postoperatively were 8.8% (n = 9) and 4.9% (n = 5), respectively. There was no type 1a endoleak, whereas retrograde type A dissection occurred in 2 (2.0%) patients. The rate of late aortic events was 3.9% (n = 4); there were no late endoleaks or aneurysm ruptures. The 10-year survival rate was 73.7% [95% confidence interval (CI) 60.3-83.8%]. The 10-year rates of aorta-related deaths and aortic events when performing a competitive-risk analysis were 29.4% (95% CI 16.3-42.5%) and 7.2 (95% CI 23.0-51.4%), respectively.
Satisfactory early and long-term results of a hybrid TEVAR with a zone 0 landing were achieved using our treatment strategy. When performing hybrid TEVAR in zone 0, postoperative aortic events may be reduced by accurate preoperative assessment of the ascending aorta.
胸主动脉腔内修复术（TEVAR）已逐渐扩展至主动脉弓区域，治疗效果得以改善。然而，杂交 TEVAR 中卒中与内漏的发生率仍居高不下。本研究旨在明确应用治疗策略的零区杂交 TEVAR 的有效性。
2008 年 4 月至 2020 年 3 月，共有 102 例患者纳入本研究，中位随访时间为 3.2 年。手术包括 62 例行全分支 TEVAR 并置换升主动脉、19 例行全分支 TEVAR 并升主动脉带环以及 21 例行全分支 TEVAR 而不进行升主动脉带环。
30 天死亡率和院内死亡率分别为 1.0%（n=1）和 3.9%（n=4）。术后 30 天内主动脉并发症和内漏的发生率分别为 8.8%（n=9）和 4.9%（n=5）。无 1a 型内漏，2 例（2.0%）发生逆行型 A 型夹层。晚期主动脉事件的发生率为 3.9%（n=4）；无晚期内漏或动脉瘤破裂。10 年生存率为 73.7%[95%置信区间（CI）60.3-83.8%]。竞争风险分析显示，10 年主动脉相关死亡率和主动脉事件发生率分别为 29.4%（95%CI 16.3-42.5%）和 7.2%（95%CI 23.0-51.4%）。
采用我们的治疗策略，零区杂交 TEVAR 可获得满意的早期和长期效果。在零区行杂交 TEVAR 时，通过准确的术前评估升主动脉，可能减少术后主动脉事件的发生。
