Ho Jacky Y K, Kim Chong Hoon, Chow Simon C Y, Kwok Micky W T, Lee Ha, Kim Tae-Hoon, Fujikawa Takuya, Wong Randolph H L, Song Suk-Won
Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
Department of Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea.
J Thorac Dis. 2023 Feb 28;15(2):484-493. doi: 10.21037/jtd-22-1055. Epub 2023 Feb 22.
Aortic arch pathology often requires staged segmental repairs. Total aortic arch replacement with frozen elephant trunk (FET) offers surgical options for these pathologies. The Jotec E-vita Open NEO™ branched prosthesis was introduced in 2020; we sought to share our initial experience focusing on the prosthesis selection strategies, surgical techniques, anastomosis-bleeding and graft-oozing control methods, and early clinical outcomes from two Asian centers.
We performed a retrospective cohort study in patients with aortic arch pathologies who underwent total arch replacement using the FET procedure with Jotec E-vita Open NEO™ branched prosthesis from two Asian centers between October 2020 and August 2021. The primary outcome was overall 30-day mortality, and the secondary outcomes were operative complications.
Twenty-five consecutive patients underwent total arch replacement with FET with the novel hybrid prosthesis. Overall 30-day mortality from both centers was 0%. Overall mean operative, cardiopulmonary bypass, hypothermic circulatory arrest, and selective antegrade cerebral perfusion times were 353.4±80.5, 183.2±39.6, 57.2±14.7, and 138.2±28.6 minutes, respectively. No patient developed stroke. Permanent spinal cord injury (SCI) was recorded in one patient (4%) and one (4%) had transient lower limb weakness that resolved after spinal drainage. There was no requirement of re-sternotomy for hemostasis.
We reported a multicenter Asian case series with the novel FET hybrid prosthesis demonstrating the feasibility and safety of promising initial clinical outcomes. The technique of circumferential reinforcement of vascular anastomosis for hemostasis may be one of the methods for lowering the rates of re-sternotomy for hemostasis, and proper surgical or transfusion strategies would overcome the excessive oozing of the prosthesis. Long-term follow-up is required for further evaluation of aortic pathology progression and device-related outcomes.
主动脉弓病变通常需要分期节段性修复。带冰冻象鼻（FET）的全主动脉弓置换术为这些病变提供了手术选择。Jotec E-vita Open NEO™分支型人工血管于2020年推出；我们试图分享我们的初步经验，重点关注人工血管选择策略、手术技术、吻合口出血和移植物渗血控制方法，以及来自两个亚洲中心的早期临床结果。
我们对2020年10月至2021年8月期间在两个亚洲中心接受使用Jotec E-vita Open NEO™分支型人工血管的FET手术进行全弓置换的主动脉弓病变患者进行了一项回顾性队列研究。主要结局是30天总体死亡率，次要结局是手术并发症。
连续25例患者接受了使用新型混合人工血管的FET全弓置换术。两个中心的30天总体死亡率均为0%。总体平均手术时间、体外循环时间、低温循环停滞时间和选择性顺行脑灌注时间分别为353.4±80.5、183.2±39.6、57.2±14.7和138.2±28.6分钟。没有患者发生中风。1例患者（4%）出现永久性脊髓损伤（SCI），1例（4%）出现短暂性下肢无力，经脊髓引流后缓解。无需再次开胸止血。
我们报告了一个使用新型FET混合人工血管的多中心亚洲病例系列，证明了有前景的初始临床结果的可行性和安全性。用于止血的血管吻合口环周加固技术可能是降低再次开胸止血率的方法之一，适当的手术或输血策略将克服人工血管的过度渗血。需要进行长期随访以进一步评估主动脉病变进展和与器械相关的结局。
