Hameed Irbaz, Ahmed Adham, Pupovac Stevan, Nassiri Naiem, Assi Roland, Vallabhajosyula Prashanth
Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Division of Vascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.
JTCVS Open. 2023 Dec 21;17:23-36. doi: 10.1016/j.xjon.2023.12.004. eCollection 2024 Feb.
For high-risk patients with aortic arch pathology, hybrid aortic arch repair with simultaneous or staged thoracic endovascular repair of the descending aorta may be a viable alternative to open repair. However, data on postintervention aortic remodeling remain limited. We report the short-term outcomes of remodeling of the thoracoabdominal aorta after hybrid arch repair + thoracic endovascular repair.
All patients undergoing hybrid arch repair with planned zones 0 to 5 thoracic endovascular repair from January 2020 to March 2022 were retrospectively reviewed. Computed tomography angiography scans preoperatively, after hybrid aortic arch repair, and on long-term follow-up were analyzed for thoracoabdominal aorta remodeling. Mean change in aortic true luminal diameter and full luminal diameter was calculated at every level, and paired-samples test was used to compare means.
Of 39 patients, 38 had follow-up data at a mean duration of 14.9 months. There were a total of 3 (7.7%) deaths, 0 (0.0%) strokes, and 0 (0.0%) paralysis. For the 35 patients undergoing thoracic endovascular repair for aortic dissection, at follow-up, there was a significant increase in the mean true luminal diameter at each level ( < .05), except at the aortic bifurcation and common iliac arteries. The largest increase in mean true luminal diameter ( < .01) was observed at the level of the left inferior pulmonary vein (mean difference +13.22 mm, 95% CI, 10.38-16.07), tracheal carina (mean difference +13.06 mm, 95% CI, 10.05-16.07), and inferior left atrium (mean difference +11.19 mm, 95% CI, 7.84-14.53).
Hybrid arch repair with zones 0 to 5 leads to improved true lumen augmentation in zones 0 to 8 with complete false lumen thrombosis down to zone 5 at short-term follow-up. Zones 9 to 11, if involved, may require adjunctive treatment strategies for total aortic remodeling and complete false lumen obliteration.
对于患有主动脉弓病变的高危患者，采用杂交主动脉弓修复术并同期或分期进行降主动脉腔内修复术可能是开放修复术的一种可行替代方案。然而，关于干预后主动脉重塑的数据仍然有限。我们报告了杂交弓修复术+胸主动脉腔内修复术后胸腹主动脉重塑的短期结果。
回顾性分析2020年1月至2022年3月期间所有接受杂交弓修复术并计划进行0至5区胸主动脉腔内修复术的患者。对术前、杂交主动脉弓修复术后及长期随访时的计算机断层扫描血管造影进行分析，以评估胸腹主动脉重塑情况。计算每个层面主动脉真腔直径和全腔直径的平均变化，并采用配对样本检验比较均值。
39例患者中，38例有随访数据，平均随访时间为14.9个月。共有3例（7.7%）死亡，0例（0.0%）中风，0例（0.0%）瘫痪。对于35例行胸主动脉腔内修复术治疗主动脉夹层的患者，随访时，除主动脉分叉和髂总动脉外，各层面的平均真腔直径均显著增加（<0.05）。在左下肺静脉水平（平均差异+13.22mm，95%CI，10.38 - 16.07）、气管隆突（平均差异+13.06mm，95%CI，10.05 - 16.07）和左心房下部（平均差异+11.19mm，95%CI，7.84 - 14.53）观察到平均真腔直径增加最大（<0.01）。
0至5区杂交弓修复术在短期随访时可使0至8区真腔扩大改善，假腔完全血栓形成至5区。9至11区若受累，可能需要辅助治疗策略以实现全主动脉重塑和假腔完全闭塞。
