Okamura Homare, Azuma Shuhei, Kitada Yuichiro, Shimada Ryo, Nomura Yohei, Adachi Hideo
Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan.
Department of Cardiovascular Surgery, Kyoto Katsura Hospital, Kyoto, Japan.
JTCVS Tech. 2024 Aug 22;27:1-8. doi: 10.1016/j.xjtc.2024.08.004. eCollection 2024 Oct.
The fenestrated frozen elephant trunk (FET) technique provides proximalization of distal anastomosis and antegrade blood flow into supra-aortic vessels through fenestration in a FET. We investigated the outcomes of the fenestrated FET technique in acute type A aortic dissection.
We evaluated 150 patients who underwent arch repair using the fenestrated FET technique for acute type A aortic dissection between July 2014 and January 2023. FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision on the supra-aortic vessel aspect. Fenestration was performed for the left subclavian artery alone in 139 patients, 2 supra-aortic vessels in 9 patients, and total supra-aortic vessels in 2 patients. Fixation around fenestration site for endoleak prevention was performed in 48 patients.
The overall 30-day mortality rate was 4.7% (7 out of 150). Two patients developed paraparesis. Adequate blood flow into the supra-aortic vessels through fenestrations were confirmed in all patients at discharge. The false lumen thrombosis rate at the distal edge of FET was 96.6%. The median follow-up period was 28 months. The 1-year and 3-year overall survival rate was 89.1% and 84.5%, respectively. During the follow-up period, neither fenestration occlusion nor stroke was noted in the cerebral area perfused via the fenestration. Distal stent graft-induced new entry was noted in 2 patients.
The fenestrated FET technique is a straightforward and secure procedure for selected patients with acute type A aortic dissection. This technique can facilitate arch repair.
带孔冰冻象鼻（FET）技术可使远端吻合口近端化，并通过FET上的开窗实现顺行血流进入主动脉弓上血管。我们研究了带孔FET技术在急性A型主动脉夹层中的治疗效果。
我们评估了2014年7月至2023年1月期间150例行带孔FET技术主动脉弓修复术治疗急性A型主动脉夹层的患者。FET在低温循环停搏下植入，并在直视下于主动脉弓上血管处手工开窗。139例患者仅为左锁骨下动脉开窗，9例患者为2支主动脉弓上血管开窗，2例患者为全部主动脉弓上血管开窗。48例患者在开窗部位周围进行固定以预防内漏。
30天总死亡率为4.7%（150例中有7例）。2例患者出现下肢轻瘫。所有患者出院时均证实通过开窗有足够的血流进入主动脉弓上血管。FET远端边缘的假腔血栓形成率为96.6%。中位随访期为28个月。1年和3年总生存率分别为89.1%和84.5%。随访期间，经开窗灌注的脑区未发现开窗闭塞或卒中。2例患者出现远端支架移植物引起的新破口。
对于选定的急性A型主动脉夹层患者，带孔FET技术是一种直接且安全的手术方法。该技术可促进主动脉弓修复。
