Pichlmaier Maximilian, Buech Joscha, Tsilimparis Nikolaos, Fabry Thomas G, Joskowiak Dominik, Rustum Saad, Martens Andreas, Hagl Christian, Peterss Sven
Department of Cardiac Surgery, LMU University Hospital, Munich, Germany.
Division of Vascular Surgery, LMU University Hospital, Munich, Germany.
Ann Thorac Surg. 2022 May;113(5):1491-1497. doi: 10.1016/j.athoracsur.2021.05.074. Epub 2021 Jun 26.
The supraaortic vessel anastomosis stent bridging (SAVSTEB) technique simplifies the reattachment of the supraaortic vessels in aortic arch surgery; however, follow-up data are limited. The study aimed to investigate the stent-related performance and complications.
Between February 2009 and September 2020, 112 patients underwent total arch replacement with a tetrabranched graft and using the SAVSTEB technique. Mean age was 59.3±12.7 years, and male gender prevailed. Nineteen percent of these patients had acute aortic dissection extending into the supraaortic vessels, 12% had chronically dissected vessels, and 70% had unaffected vessels. The left subclavian artery, left common carotid artery, and innominate artery were bridged in 88%, 75%, and 2%, respectively, and an aberrant right subclavian artery was bridged in 2%.
Total stent experience was 341 stent-years, and stent patency was found in 98%. Technical success was achieved in all but 1 case. One percent of patients had major stent thrombosis requiring reintervention. Minor stent thrombosis was found in 2%. No endoleak was found, and the number of new-onset dissections distal to the stent was 4%. Freedom from stent-related events was estimated at 89.1% ± 0.5% at 3 years. The stroke rate was 10%, with the highest incidence among nondissected vessels. The vertebral artery was overstented in 15%, and 2% of these cases were associated radiographically with stroke.
SAVSTEB is a comparatively simple, safe, and efficacious technique to create the anastomosis between tetrabranched arch grafts and the supraaortic arteries in the short and intermediate term. Bleeding from the anastomoses, kinking, and scar-associated stenosis are negligible; however, vertebral overstenting remains a critical technical issue.
主动脉弓上血管吻合支架桥接（SAVSTEB）技术简化了主动脉弓手术中主动脉弓上血管的重新连接；然而，随访数据有限。本研究旨在调查支架相关性能和并发症。
2009年2月至2020年9月期间，112例患者接受了四分支移植物全弓置换术，并采用SAVSTEB技术。平均年龄为59.3±12.7岁，男性居多。这些患者中，19%有急性主动脉夹层延伸至主动脉弓上血管，12%有慢性夹层血管，70%血管未受影响。左锁骨下动脉、左颈总动脉和无名动脉的桥接率分别为88%、75%和2%，异常右锁骨下动脉的桥接率为2%。
支架总使用年限为341个支架年，支架通畅率为98%。除1例患者外，所有患者均取得技术成功。1%的患者发生严重支架血栓形成，需要再次干预。2%的患者发现轻微支架血栓形成。未发现内漏，支架远端新发夹层的发生率为4%。3年时无支架相关事件的发生率估计为89.1%±0.5%。卒中发生率为10%，在未夹层血管中发生率最高。15%的患者椎动脉支架置入过度，其中2%的病例影像学检查与卒中相关。
SAVSTEB是一种相对简单、安全且有效的技术，可在短期和中期实现四分支弓状移植物与主动脉弓上动脉之间的吻合。吻合口出血、扭结和瘢痕相关狭窄可忽略不计；然而，椎动脉支架置入过度仍然是一个关键的技术问题。
