Arakawa Mamoru, Akiyoshi Kei, Kitada Yuichiro, Miyagawa Atsushi, Okamura Homare
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, 2-11-1 Hikarigaoka, Nerima-Ku, Tokyo, 179-0075, Japan.
Department of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jan;73(1):23-30. doi: 10.1007/s11748-024-02045-7. Epub 2024 May 29.
Zone 2 anastomosis with total cervical branch reconstruction for acute type A aortic dissection and aortic arch aneurysms became possible after stent-graft introduction. This may be an easier procedure and reduce the risk of recurrent laryngeal nerve palsy. Therefore, this study aimed to compare the outcomes between Zone 2 and Zone 3 distal anastomoses.
After evaluating the patient data in our institute between April 2016 and April 2022, the patients in whom distal anastomosis was performed at Zone 2 with a stent-graft were defined as the Zone 2 group (n = 70). The patients in whom distal anastomosis was performed at Zone 3 were defined as the Zone 3 group (n = 24).
The incidence of new-onset recurrent nerve palsy was one patient (1.4%) in the Zone 2 group and six patients (25.0%) in the Zone 3 group (p < 0.001). The lower body perfusion arrest time was 44.3 ± 9.1 min in the Zone 2 group and 52.9 ± 12.8 min in the Zone 3 group (p = 0.005). There were no significant differences in in-hospital mortality and morbidities. Multivariable analysis showed that only age was an independent predictor of overall mortality.
Performing distal anastomosis at Zone 2 with a frozen elephant trunk or stent-graft reduced the lower body perfusion arrest time and possibly prevented recurrent nerve palsy.
在引入支架型人工血管后，二区吻合术联合颈总分支重建用于急性A型主动脉夹层和主动脉弓动脉瘤成为可能。这可能是一种更简便的手术方式，并可降低喉返神经麻痹的风险。因此，本研究旨在比较二区和三区远端吻合术的疗效。
评估我院2016年4月至2022年4月期间的患者数据，将采用支架型人工血管在二区进行远端吻合术的患者定义为二区组（n = 70）。将在三区进行远端吻合术的患者定义为三区组（n = 24）。
二区组新发喉返神经麻痹的发生率为1例（1.4%），三区组为6例（25.0%）（p < 0.001）。二区组下半身灌注停循环时间为44.3±9.1分钟，三区组为52.9±12.8分钟（p = 0.005）。住院死亡率和发病率无显著差异。多变量分析显示，只有年龄是总体死亡率的独立预测因素。
采用带膜支架象鼻或支架型人工血管在二区进行远端吻合术可缩短下半身灌注停循环时间，并可能预防喉返神经麻痹。
