Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2022 Jul 11;62(2). doi: 10.1093/ejcts/ezac384.
A novel hybrid non-covered stent was developed to treat malperfusion and prevent aneurysm formation following hemiarch procedure for DeBakey I acute aortic dissection (AAD). The present analysis investigates the performance of the device in 100 consecutive implantations.
Between 2018 and 2021, 100 patients underwent surgical repair of DeBakey I AAD with implantation of a non-covered stent in the arch and descending aorta. The primary entry tear was located in the root or the ascending aorta. Clinical and imaging data were collected and analysed retrospectively. The endpoints of the study were 30-day mortality, neurological outcome and need of additional procedures due to postoperative malperfusion. Technical success was assessed in the first postoperative computed tomography in regard to the induction of false lumen thrombosis in the descending aorta.
The median age was 61 (54-73) years. Preoperative malperfusion was present in 46 (46%) patients. The primary arterial cannulation strategy was the right axillary artery and an open distal anastomosis was performed in a median caudal circulatory arrest of 40 (34-52) min. In 48% of cases, a 55-40 tapered stent was implanted. The 30-day mortality was 18%, and the operation-related new postoperative neurological deficit was present in 8%. Technical success was achieved in 76% of patients.
The novel non-covered stent can be safely applied to complement aortic repair with the hemiarch procedure for DeBakey I AAD. The expansion of the true lumen through the device may prevent postoperative malperfusion and induces positive vascular remodelling with the thrombosis of the false lumen.
开发了一种新型混合非覆膜支架，用于治疗 DeBakey I 型急性主动脉夹层（AAD）半弓手术后的灌注不良和预防动脉瘤形成。本分析调查了该装置在 100 例连续植入中的性能。
2018 年至 2021 年，100 例 DeBakey I AAD 患者接受手术修复，在弓部和降主动脉植入非覆膜支架。主要入口撕裂位于根部或升主动脉。回顾性收集和分析临床和影像学数据。本研究的终点是 30 天死亡率、神经结局和因术后灌注不良需要额外手术。在术后首次计算机断层扫描中评估技术成功，以评估降主动脉假腔血栓形成的诱导。
中位年龄为 61（54-73）岁。术前灌注不良 46 例（46%）。主要动脉插管策略是右侧腋窝动脉，中位腹主动脉循环阻断时间为 40（34-52）分钟，行开放远端吻合术。在 48%的病例中，植入了 55-40 锥形支架。30 天死亡率为 18%，术后新出现的与手术相关的神经功能缺损为 8%。76%的患者达到了技术成功。
新型非覆膜支架可安全应用于补充 DeBakey I AAD 的半弓手术。该装置通过扩张真腔可能预防术后灌注不良，并通过假腔血栓形成诱导积极的血管重塑。
