Hegeman Romy R M J J, Swaans Martin J, Kara Basak, Heijmen Robin H, Smeenk Hans G, Timmers Leo, Sonker Uday, Klein Patrick, Berg Jurriën M Ten
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2023 Oct;31(10):383-389. doi: 10.1007/s12471-023-01784-1. Epub 2023 May 31.
Postsurgical thoracic aortic pseudoaneurysms (PTAPs) are a potentially lethal complication after cardiac or aortic surgery. Surgical management can pose a challenge with high in-hospital mortality rates. Transcatheter closure is a less-invasive alternative treatment option for selected patients, although current experience is limited.
We aimed to evaluate procedural and imaging outcomes of our first 11 cases of transcatheter PTAP closure with the use of closure devices.
Patients with a high operative risk who underwent transcatheter PTAP closure at our centre from 2019 to 2021 were retrospectively included. Suitability was evaluated on preprocedural computed tomography (CT) scans and three-dimensional (3D) reconstructions. All procedures were performed in the catheterisation laboratory. Intraprocedural aortography and postprocedural CT scans with 3D reconstructions were used to evaluate PTAP occlusion.
Eleven consecutive patients with a high operative risk and a history of cardiac/aortic surgery who underwent transcatheter PTAP closure were included. PTAPs were predominantly located at the proximal or distal anastomosis of a supracoronary ascending aortic vascular graft or Bentall prosthesis (82%). Implanted closure devices included Amplatzer Valvular Plug III (82%), Amplatzer septal occluder (9%) and Occlutech atrial septal defect occluder (9%). No periprocedural complications occurred. After device deployment, residual flow was absent on aortography in 64% and minimal residual flow was present in 36% of patients. Subtotal or total occlusion of the PTAP on follow-up CT ranged between 45% and 73%.
Although subtotal or total occlusion of the PTAP was found at follow-up in only 45-73% of cases, transcatheter PTAP closure guided by preprocedural 3D reconstructions can offer a valuable minimally invasive primary treatment option for patients who otherwise would face a high-risk reoperation.
术后胸主动脉假性动脉瘤（PTAP）是心脏或主动脉手术后一种潜在致命的并发症。手术治疗可能具有挑战性，住院死亡率较高。经导管封堵术是一种针对特定患者的侵入性较小的替代治疗选择，尽管目前经验有限。
我们旨在评估使用封堵装置对11例PTAP进行经导管封堵的手术及影像学结果。
回顾性纳入2019年至2021年在我们中心接受经导管PTAP封堵且手术风险高的患者。术前通过计算机断层扫描（CT）和三维（3D）重建评估其适用性。所有手术均在导管室进行。术中主动脉造影和术后带3D重建的CT扫描用于评估PTAP封堵情况。
纳入11例连续的手术风险高且有心脏/主动脉手术史并接受经导管PTAP封堵的患者。PTAP主要位于冠状动脉上方升主动脉血管移植物或Bentall人工心脏瓣膜近端或远端吻合口处（82%）。植入的封堵装置包括Amplatzer瓣膜封堵器III型（82%）、Amplatzer房间隔封堵器（9%）和Occlutech房间隔缺损封堵器（9%）。围手术期未发生并发症。装置置入后，64%的患者主动脉造影显示无残余血流，36%的患者有微量残余血流。随访CT显示PTAP部分或完全封堵的比例在45%至73%之间。
尽管随访时仅45%-73%的病例中发现PTAP部分或完全封堵，但术前3D重建引导下的经导管PTAP封堵可为否则将面临高风险再次手术的患者提供有价值的微创初始治疗选择。
