马凡综合征患者行冰冻象鼻手术联合 Evita 开放型覆膜支架的早期和中期结果：一项多中心研究的结果。

Early and midterm results of frozen elephant trunk operation with Evita open stent-graft in patients with Marfan syndrome: results of a multicentre study.

机构信息

Department of Cardiac Surgery, University of Rzeszow Poland, 60 Lwowska Street 60, 35-301, Rzeszow, Poland.

Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Essen, Germany.

出版信息

BMC Cardiovasc Disord. 2022 Jul 26;22(1):333. doi: 10.1186/s12872-022-02777-5.

DOI:10.1186/s12872-022-02777-5

PMID:35883019

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9317434/

Abstract

BACKGROUND

Endovascular treatment of patients with Marfan syndrome (MFS) is not recommended. Hybrid procedures such as frozen elephant trunk (FET), which combines stent-graft deployment with an integrated non-stented fabric graft for proximal grafting and suturing, have not been previously evaluated. The aim of this study was to assess the safety and feasibility of FET operation in patients with MFS.

METHODS

Patients enrolled in the International E-vita Open Registry (IEOR) who underwent FET procedure between January 2001 and February 2020 meeting Ghent criteria for MFS were included in the study. Early and midterm results were retrospectively analyzed. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed.

RESULTS

We analyzed 37 patients [mean age 38 ± 11 years, 65% men]. Acute or chronic aortic dissection was present in 35 (95%) patients (14 and 21 patients respectively). Two (5%) patients had an aneurysm without dissection. Malperfusion syndrome was present in 4 patients. Twenty-nine (78%) patients had history of aortic surgical interventions. The 30-day and in-hospital mortality amounted to 8 and 14% respectively. False lumen exclusion was present in 73% in stented segment in last postoperative CT. The overall 5-year survival was 71% and freedom from reintervention downstream was 58% at 5 years. Of the nine patients who required reintervention for distal aortic disease, one patient died.

CONCLUSIONS

FET operation for patients with MFS can be performed with acceptable mortality and morbidity. In long-term follow-up no reinterventions on the aortic arch were required. FET allows for easier second stage operations providing platform for surgical and endovascular reinterventions.

摘要

背景

不建议对马凡综合征（MFS）患者进行血管内治疗。杂交手术，如冷冻象鼻（FET），将支架移植物放置与一体式非支架织物移植物结合使用，用于近端移植和缝合，尚未进行过评估。本研究旨在评估 FET 手术在 MFS 患者中的安全性和可行性。

方法

本研究纳入了 2001 年 1 月至 2020 年 2 月期间在国际 E-vita Open 注册中心（IEOR）接受 FET 手术且符合根特标准的 MFS 患者。回顾性分析了早期和中期结果。分析了术前、术后和随访的计算机断层血管造影扫描。

结果

我们分析了 37 例患者[平均年龄 38±11 岁，65%为男性]。35 例（95%）患者存在急性或慢性主动脉夹层（分别为 14 例和 21 例）。2 例（5%）患者存在无夹层的动脉瘤。4 例患者存在灌注不良综合征。29 例（78%）患者有主动脉手术干预史。30 天和住院死亡率分别为 8%和 14%。最后一次术后 CT 显示支架段假腔闭塞率为 73%。总体 5 年生存率为 71%，5 年下游无再干预率为 58%。在需要进行远端主动脉疾病再干预的 9 例患者中，有 1 例患者死亡。