Zhang Bowen, Sun Xiaogang, Liu Yanxiang, Dun Yaojun, Liang Shenghua, Yu Cuntao, Qian Xiangyang, Gao Haoyu, Ren Jie, Wang Luchen, Zhou Sangyu
Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Cardiovasc Med. 2022 Feb 28;9:820653. doi: 10.3389/fcvm.2022.820653. eCollection 2022.
Hybrid total arch replacement (HTAR) was an alternative for type A aortic dissection (TAAD). This study aimed to evaluate the clinical and radiographical outcomes of HTAR for TAAD and to evaluate the clinical outcomes of performing this procedure under mild hypothermia.
A total of 209 patients who underwent HTAR for TAAD were retrospectively analyzed and stratified into mild ( = 48) and moderate ( = 161) hypothermia groups to evaluate the effects of mild hypothermia on the clinical outcomes. Long-term clinical outcomes were evaluated by the overall survival and adverse aortic events (AAEs). A total of 176 patients with preoperative and at least one-time postoperative aortic computed tomography angiography in our institute were included for evaluating the late aortic remodeling (aortic diameter and false lumen thrombosis).
The median follow-up period was 48.3 (interquartile range [IQR] = 28.4-73.7) months. The overall survival rate was 88.0, 83.2, and 77.1% at the 1, 5, and 10 years, respectively, and in the presence of death as a competing risk, the cumulative incidence of AAEs was 4.8, 9.9, and 12.1% at the 1, 5, and 10 years. The aortic diameters were stable in the descending thoracic and abdominal aorta ( > 0.05 in all the measured aortic segments). A total of 100% complete false lumen thrombosis rate in the stent covered and distal thoracic aorta were achieved at 1 year (64/64) and 4 years (18/18), respectively after HTAR. The overall composite adverse events morbidity and mortality were 18.7 and 10.0%. Mild hypothermia (31.2, IQR = 30.2-32.0) achieved similar composite adverse events morbidity (mild: 14.6 vs. moderate: 19.9%, = 0.41) and early mortality (mild: 10.4 vs. moderate: 9.9%, = 1.00) compared with moderate hypothermia (median 27.7, IQR = 27-28.1) group, but mild hypothermia group needed shorter cardiopulmonary bypass (mild: 111, IQR = 93-145 min vs. moderate: 136, IQR = 114-173 min, < 0.001) and aortic cross-clamping (mild: 45, IQR = 37-56 min vs. moderate: 78, IQR = 54-107 min, < 0.001) time.
Hybrid total arch replacement achieved desirable early and long-term clinical outcomes for TAAD. Performing HTAR under mild hypothermia was as safe as under moderate hypothermia. After HTAR for TAAD, dissected aorta achieved desirable aortic remodeling, presenting as stable aortic diameters and false lumen complete thrombosis. In all, HTAR is a practical treatment for TAAD.
杂交全弓置换术（HTAR）是A型主动脉夹层（TAAD）的一种替代治疗方法。本研究旨在评估HTAR治疗TAAD的临床和影像学结果，并评估在轻度低温下进行该手术的临床效果。
对209例行HTAR治疗TAAD的患者进行回顾性分析，并分为轻度低温组（n = 48）和中度低温组（n = 161），以评估轻度低温对临床结果的影响。通过总生存率和主动脉不良事件（AAEs）评估长期临床结果。纳入我院176例术前及至少一次术后主动脉计算机断层扫描血管造影的患者，以评估晚期主动脉重塑（主动脉直径和假腔血栓形成）。
中位随访期为48.3（四分位间距[IQR]=28.4 - 73.7）个月。1年、5年和10年的总生存率分别为88.0%、83.2%和77.1%，在将死亡作为竞争风险的情况下，1年、5年和10年AAEs的累积发生率分别为4.8%、9.9%和12.1%。胸降主动脉和腹主动脉的直径稳定（所有测量的主动脉节段P>0.05）。HTAR术后1年（64/64）和4年（18/18）时，支架覆盖段和胸主动脉远端的假腔完全血栓形成率分别达到100%。总的复合不良事件发病率和死亡率分别为18.7%和10.0%。与中度低温组（中位温度27.7，IQR = 27 - 28.1）相比，轻度低温组（31.2，IQR = 30.2 - 32.0）的复合不良事件发病率（轻度：14.6% vs. 中度：19.9%，P = 0.41）和早期死亡率（轻度：10.4% vs. 中度：9.9%，P = 1.00）相似，但轻度低温组所需的体外循环时间较短（轻度：111，IQR = 93 - 145分钟 vs. 中度：136，IQR = 114 - 173分钟，P<0.001）和主动脉阻断时间较短（轻度：45，IQR = 37 - 56分钟 vs. 中度：78，IQR = 54 - 107分钟，P<0.001）。
杂交全弓置换术对TAAD取得了理想的早期和长期临床效果。在轻度低温下进行HTAR与在中度低温下一样安全。TAAD行HTAR术后，夹层主动脉实现了理想的主动脉重塑，表现为主动脉直径稳定和假腔完全血栓形成。总之，HTAR是TAAD的一种切实可行的治疗方法。
