Department of Cardiovascular Surgery, University Heart Centre Freiburg University, Freiburg, Germany.
Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Interact Cardiovasc Thorac Surg. 2021 Jul 26;33(2):269-275. doi: 10.1093/icvts/ivab062.
The goal of this study was to describe our 3-step approach to treat multisegmental thoraco-abdominal aortic disease due to aortic dissection and to present our initial clinical results.
Nine patients with multisegmental thoraco-abdominal aortic pathology due to aortic dissection underwent our 3-step approach, which consisted of total aortic arch replacement via the frozen elephant trunk technique, thoracic endovascular aortic repair for distal extension down to the level of the thoraco-abdominal transition and, finally, open thoraco-abdominal aortic replacement for the remaining downstream aortic segments. We assessed their baseline and aortic characteristics, previous aortic procedures, intraoperative details, clinical outcomes and follow-up data.
The median age was 58 (42-66) years; 4 patients (44%) presented connective tissue disease. Eight patients (89%) had undergone previous aortic surgery for aortic dissection. In-hospital mortality was 0% (n = 0). None suffered symptomatic spinal cord injury or disabling stroke. During the follow-up period, 1 patient died of acute biliary septic shock 6 months after thoraco-abdominal aortic replacement.
The 3-step approach to treat multisegmental thoraco-abdominal aortic pathology due to aortic dissection, which involves applying both open and endovascular techniques, is associated with an excellent clinical outcome and low perioperative risk. Distal shifting of the disease process through the thoracic endovascular aortic repair extension-and thereby necessitating limited open thoraco-abdominal aortic repair-seems to be the major factor enabling these favourable results.
IRB approval was obtained (No. 425/15) from the institutional review board of the University of Freiburg.
本研究旨在描述我们治疗因主动脉夹层导致的多节段胸腹主动脉疾病的三步法，并介绍我们的初步临床结果。
9 例因主动脉夹层导致多节段胸腹主动脉病变的患者接受了我们的三步法治疗，该方法包括通过冷冻象鼻技术进行全主动脉弓置换、胸主动脉腔内修复术进行远端延伸至胸腹交界以下以及最后进行开放胸腹主动脉置换术治疗剩余下游主动脉节段。我们评估了他们的基线和主动脉特征、既往主动脉手术、手术细节、临床结果和随访数据。
中位年龄为 58（42-66）岁；4 例（44%）患者存在结缔组织疾病。8 例（89%）患者因主动脉夹层而行既往主动脉手术。院内死亡率为 0%（n=0）。无患者发生症状性脊髓损伤或致残性卒中。在随访期间，1 例患者在胸腹主动脉置换后 6 个月死于急性胆道感染性休克。
治疗因主动脉夹层导致的多节段胸腹主动脉病变的三步法，包括应用开放和腔内技术，具有极好的临床效果和低围手术期风险。通过胸主动脉腔内修复术延伸使病变过程向远端移位，从而需要进行有限的开放胸腹主动脉修复，这似乎是实现这些有利结果的主要因素。
IRB 批准：本研究获得了弗莱堡大学机构审查委员会的批准（No. 425/15）。
