Park Sung Jun, Kim Jin Kyung, Kim Hong Rae, Kim Taehun, Lee Sangwook, Kim Guk Bae, Yang Dong Hyun, Kim Joon Bum
Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
JTCVS Tech. 2023 May 8;20:1-9. doi: 10.1016/j.xjtc.2023.04.011. eCollection 2023 Aug.
Paraplegia is a distressing complication after open thoracoabdominal aortic aneurysm (TAAA) repair, and revascularization of T8-L2-level segmental arteries is considered pivotal to prevent paraplegia. We employed 3-dimensional (3D) printing to efficiently revascularize segmental/visceral arteries and prospectively evaluated its safety and efficacy.
From January 1, 2020, to June 30, 2022, we prospectively enrolled patients of extent I, II, or III TAAA repair. Guidance models were 3D-printed based on preoperative computed tomography, and multibranched aortic grafts were manually constructed upon this model before surgery. The composite outcome of operative mortality, permanent stroke, and permanent spinal cord deficit (SCD) was compared with the historical control group (n = 77, in 2015-2020), subjected to similar TAAA repair without 3D printing.
A total of 38 patients (58.6 ± 13.2 years) underwent open TAAA repair with the aid of 3D printing. Extent I, II, and III repairs were performed in 14 (36.8%), 17 (44.7%), and 7 (18.4%), respectively. Concomitant arch repair and bi-iliac reconstruction were performed in 7 (18.4%) and 6 patients (15.8%), respectively. Mean pump time was 107.7 ± 55.5 minutes. Operative mortality, permanent stroke, and permanent SCD each occurred in 1 patient (2.6%), and the incidence of the composite outcome was 7.9% (3/38). In the control group, mean pump time was 166.0 ± 83.9 minutes, significantly longer than the 3D-printing group ( < .001), and operative mortality, permanent stroke, permanent SCD, and the composite outcome occurred in 7 (9.1%), 9 (11.7%), 8 (10.4%), and 19 (24.7%), respectively.
Open repairs of extensive TAAA with 3D printing showed favorable safety and efficacy, which need further validation by larger studies.
截瘫是开放性胸腹主动脉瘤（TAAA）修复术后令人痛苦的并发症，T8 - L2节段动脉的血运重建被认为是预防截瘫的关键。我们采用三维（3D）打印技术有效地实现节段性/内脏动脉的血运重建，并前瞻性评估其安全性和有效性。
从2020年1月1日至2022年6月30日，我们前瞻性纳入了I、II或III型TAAA修复患者。基于术前计算机断层扫描进行3D打印指导模型，并在手术前在此模型上手工构建多分支主动脉移植物。将手术死亡率、永久性卒中及永久性脊髓损伤（SCD）的复合结局与历史对照组（n = 77，2015 - 2020年）进行比较，历史对照组接受了类似的无3D打印的TAAA修复。
共有38例患者（58.6 ± 13.2岁）在3D打印辅助下接受了开放性TAAA修复。I、II和III型修复分别进行了14例（36.8%）、17例（44.7%）和7例（18.4%）。分别有7例（18.4%）和6例（15.8%）患者同时进行了主动脉弓修复和双髂动脉重建。平均体外循环时间为107.7 ± 55.5分钟。手术死亡率、永久性卒中和永久性SCD各有1例发生（2.6%），复合结局的发生率为7.9%（3/38）。在对照组中，平均体外循环时间为166.0 ± 83.9分钟，显著长于3D打印组（< 0.001），手术死亡率、永久性卒中、永久性SCD和复合结局的发生率分别为7例（9.1%）、9例（11.7%）、8例（10.4%）和19例（24.7%）。
3D打印技术用于广泛TAAA的开放性修复显示出良好的安全性和有效性，这需要通过更大规模的研究进一步验证。
