Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy.
Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy.
Cardiovasc Intervent Radiol. 2023 Dec;46(12):1674-1683. doi: 10.1007/s00270-023-03607-7. Epub 2023 Nov 17.
Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers.
Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency.
In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed.
Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.
比较两家三级血管外科中心的杂交和全腔内主动脉弓修复。
连续纳入 2008 年至 2022 年因动脉瘤或夹层而行杂交（HG）或全腔内（TEG）全主动脉弓修复的患者。主要观察终点为 30 天死亡率。次要观察终点为主要并发症、技术成功率（定义为无手术转换/死亡率、高流量内漏或分支/肢体闭塞）、临床成功率（定义为无残疾临床后遗症）、晚期和主动脉相关死亡率/再次干预、无内漏、主动脉直径生长>5mm、移植物迁移和主动脉弓上（SAT）通畅。
共纳入 30 例患者，HG 组 17 例，TEG 组 13 例。TEG 组的介入时间更短（240.5 分钟比 341 分钟，p=0.01），ICU 中位住院时间更短（1 天比 4.5 天，p<0.01），中位住院时间更短（8 天比 17.5 天，p<0.01）。无术中死亡。技术成功率为 100%；HG 组的临床成功率为 70.6%，TEG 组为 100%（p=0.05）。30 天死亡率为 13.3%，仅见于 HG 组（p=0.11）。8 例患者发生 9 例重大并发症，HG 组 5 例，TEG 组 3 例（p=0.99），其中 5 例为脑卒中，HG 组 2 例，TEG 组 3 例（p=0.62）。晚期死亡率为 38.5%，HG 组 6 例，TEG 组 4 例，p=0.6。HG 组发生 2 例主动脉相关死亡（p=0.9）。2 例主动脉相关再次干预，无移植物迁移或 SAT 闭塞。
与杂交解决方案相比，全腔内修复似乎可缩短手术时间，并提供更高的临床成功率，30 天死亡率无显著差异。最常见的主要并发症是脑卒中。
