Gao Haoyu, Wang Luchen, Liu Yanxiang, Liang Shenghua, Zhang Bowen, Ren Jie, Yu Cuntao, Sun Xiaogang
Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Surg. 2023 Jan 6;9:1044089. doi: 10.3389/fsurg.2022.1044089. eCollection 2022.
Frozen elephant trunk technique (FET) has been proven to provide an excellent landing zone for second-stage thoracoabdominal (TA) aortic repair. The aim of this study was to evaluate the impact of FET in TA aortic repair with normothermic iliac perfusion.
From January 2008 to December 2019, 144 patients undergoing TA repair with normothermic iliac perfusion were enrolled in this study. Early and mid-term outcomes of patients with previous FET implantation (group A, = 62) were compared with patients without previous FET implantation (group B, = 82). The logistic regression analysis was performed to investigate the risk factors for adverse events, which were defined as early death, permanent stroke, permanent paraplegia, or permanent renal failure necessitating dialysis.
The proximal aortic clamp time and operating time was 14.26 ± 5.57 min and 357.40 ± 94.51 respectively in group A, which were both significantly shorter than that in group B (18.67 ± 5.24 min and 18.67 ± 5.24 min). The incidence of adverse event was significantly lower in group A than that in group B (9.7% vs. 25.6%, = 0.027). There was no significant difference between two groups with regard to other complications or late outcomes. In addition, age >50 years, a Ccr < 90 ml/min/1.73 m and the operating time were identified as significant risk factors through logistic regression analysis for adverse events of TA repair.
The FET technique simplifies the operative technique of proximal anastomosis, decreases the operating time and improves the early outcomes in TA repair, whereas does not provide a significant benefit with regard to late outcomes. Long-term follow-up and studies with larger sample sizes are necessary for further confirmation.
已证实冻象鼻技术（FET）可为二期胸腹主动脉（TA）修复提供理想的着陆区。本研究旨在评估FET在常温髂动脉灌注下TA主动脉修复中的影响。
2008年1月至2019年12月，本研究纳入了144例行常温髂动脉灌注TA修复的患者。将先前植入FET的患者（A组，n = 62）与未植入FET的患者（B组，n = 82）的早期和中期结果进行比较。进行逻辑回归分析以调查不良事件的危险因素，不良事件定义为早期死亡、永久性卒中、永久性截瘫或需要透析的永久性肾衰竭。
A组近端主动脉阻断时间和手术时间分别为14.26±5.57分钟和357.40±94.51分钟，均显著短于B组（18.67±5.24分钟和423.01±101.74分钟）。A组不良事件发生率显著低于B组（9.7%对25.6%，P = 0.027）。两组在其他并发症或远期结果方面无显著差异。此外，通过逻辑回归分析确定年龄>50岁、肌酐清除率<90 ml/min/1.73m²和手术时间是TA修复不良事件的显著危险因素。
FET技术简化了近端吻合的手术技术，缩短了手术时间，改善了TA修复的早期结果，但在远期结果方面未提供显著益处。需要进行长期随访和更大样本量的研究以进一步证实。
