Dhanekula Arjune, DeGraaff Bret, Flodin Rachel, Reimann-Moody Anne, Garza Manuel De La, Zettervall Sara, Shalhub Sherene, Sweet Matthew P, Burke Christopher R, DeRoo Scott
Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
University of Washington School of Medicine, Seattle, Washington.
Aorta (Stamford). 2024 Apr;12(2):32-40. doi: 10.1055/s-0044-1795130. Epub 2024 Nov 26.
Transverse open aortic arch replacement remains a complex operation. A simplified arch replacement into zone 2, with debranching the head vessels proximally, creates a suitable landing zone for future endovascular repair and is increasing in popularity as of late. Still, limited data exist to assess contemporary rates of morbidity and mortality. Therefore, we aim to evaluate current outcomes for patients who underwent open zone 2 aortic arch replacement.
All patients who underwent zone 2 arch replacement at a single academic institution from January 2019 to June 2023 were assessed. Indication for operation was either aneurysmal disease ( = 37), acute aortic syndrome ( = 38), or residual arch/descending thoracic aorta dissection ( = 67). Patient demographics and operative characteristics were evaluated, and the frequency of subsequent thoracic endovascular aortic repair (TEVAR) was noted. Mortality and major morbidity were then assessed.
A total of 142 patients underwent open zone 2 arch replacement. Median cardiopulmonary bypass, cross-clamp, and deep hypothermic circulatory arrest times for the entire cohort were 195, 122, and 36.5 minutes, respectively. Concomitant frozen elephant trunk was performed in 45.1% of the cohort ( = 64). In-hospital mortality was 7.8% ( = 11) for the entire cohort. Spinal cord ischemia occurred in 3.5% ( = 5); these patients all received frozen elephant trunks and had neurologic recovery by discharge. Stroke occurred in 9.2% ( = 13) of the study cohort. A total of 38.7% ( = 55) went on to get subsequent TEVAR, with median time to TEVAR of 52 days (8, 98.5).
Zone 2 arch replacement allows staged repair of the thoracic aorta and readily accommodates future TEVAR therapy. This option for the treatment of the aortic arch can be performed safely in a wide variety of patient pathologies. Given the safety of this operation, cardiac surgeons should utilize this approach more frequently.
横行开放性主动脉弓置换术仍然是一项复杂的手术。简化为2区的弓部置换术，近端离断头臂血管，为未来的血管腔内修复创造了合适的着陆区，并且近来越来越受欢迎。然而，评估当代发病率和死亡率的数据仍然有限。因此，我们旨在评估接受开放性2区主动脉弓置换术患者的当前结局。
对2019年1月至2023年6月在单一学术机构接受2区弓部置换术的所有患者进行评估。手术指征为动脉瘤性疾病（n = 37）、急性主动脉综合征（n = 38）或残余弓部/胸降主动脉夹层（n = 67）。评估患者人口统计学和手术特征，并记录随后进行胸段血管腔内主动脉修复（TEVAR）的频率。然后评估死亡率和主要并发症。
共有142例患者接受了开放性2区弓部置换术。整个队列的体外循环、交叉钳夹和深低温停循环时间中位数分别为195、122和36.5分钟。45.1%（n = 64）的队列同时进行了冰冻象鼻手术。整个队列的住院死亡率为7.8%（n = 11）。脊髓缺血发生率为3.5%（n = 5）；这些患者均接受了冰冻象鼻手术，出院时神经功能恢复。研究队列中9.2%（n = 13）发生卒中。共有38.7%（n = 55）的患者随后接受了TEVAR，TEVAR的中位时间为52天（8，98.5）。
2区弓部置换术允许对胸主动脉进行分期修复，并易于接受未来的TEVAR治疗。这种治疗主动脉弓的方法可以在多种患者病变中安全实施。鉴于该手术的安全性，心脏外科医生应更频繁地采用这种方法。
