Liu Tom X, Manerikar Adwaiy, Won Daniel, Whippo Beth, Mansukhani Neel A, Hoel Andrew W, Malaisrie S Christopher, Mehta Christopher K
Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School Medicine, Chicago, Illinois.
Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School Medicine, Chicago, Illinois.
Ann Thorac Surg Short Rep. 2024 Jun 12;2(4):707-711. doi: 10.1016/j.atssr.2024.05.014. eCollection 2024 Dec.
An anomalous left vertebral artery (aLVA) can complicate aortic arch surgery. We examined the safety of various aLVA revascularization strategies during open total arch replacement.
We retrospectively evaluated 92 patients undergoing total arch replacement from January 2018 to May 2023 and identified 11 patients with aLVA. A comparison group (n = 31) with conventional 3-branched anatomy was selected by 3:1 matching on age, sex, circulatory arrest time, and operative mortality. Forty-two patients were selected for analysis. The primary outcome was perioperative stroke within 30 days. Secondary outcomes included spinal cord ischemia and long-term stroke.
Patients with aLVA had an average age of 53 ±16 years. Indications included Stanford type A dissection (n = 4), chronic dissection with aneurysmal degeneration (n = 4), and primary aneurysmal disease (n = 3). The aLVA was reconstructed by transposition to the left carotid (n = 2) or subclavian (n = 8). In 1 case, partial zone 2 arch replacement was performed proximal to the aLVA and manipulation was not required. Total arch replacement with frozen elephant trunk was performed in 8 of 11 cases. No postoperative mortality was observed. One patient experienced transient postoperative stroke (9% vs 9%, = 1.00). One patient received lumbar drain for suspected spinal cord ischemia (9% vs 7%, = 0.59). One patient experienced stroke 6 months post operation. One-year patency of transposition was 100%.
The presence of aLVA does not impact outcomes of open arch surgery. Our strategy to preserve the aLVA may be preferable to simple ligation. We describe several safe and feasible approaches for reimplantation of this anomalous variant.
异常左椎动脉（aLVA）会使主动脉弓手术复杂化。我们研究了在开放性全弓置换术中各种aLVA血运重建策略的安全性。
我们回顾性评估了2018年1月至2023年5月期间接受全弓置换的92例患者，并确定了11例aLVA患者。通过年龄、性别、循环停止时间和手术死亡率按3:1匹配选择了具有传统三支解剖结构的对照组（n = 31）。选择42例患者进行分析。主要结局是30天内围手术期卒中。次要结局包括脊髓缺血和长期卒中。
aLVA患者的平均年龄为53±16岁。适应证包括A型主动脉夹层（n = 4）、慢性夹层伴动脉瘤样退变（n = 4）和原发性动脉瘤疾病（n = 3）。aLVA通过转位至左颈动脉（n = 2）或锁骨下动脉（n = 8）进行重建。1例患者在aLVA近端进行了部分2区弓置换，无需进行操作。11例患者中有8例进行了带冰冻象鼻的全弓置换。未观察到术后死亡。1例患者发生短暂性术后卒中（9%对9%，P = 1.00）。1例患者因疑似脊髓缺血接受了腰大池引流（9%对7%，P = 0.59）。1例患者在术后6个月发生卒中。转位的1年通畅率为100%。
aLVA的存在不影响开放性弓手术的结局。我们保留aLVA的策略可能优于单纯结扎。我们描述了几种安全可行的方法来重新植入这种异常变异。
