Shimamura Junichi, Abazid Rami, Gelinas Jill, Valdis Matthew, Duncan Audra, Power Adam, Dubois Luc, Chu Michael W A
Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada.
Division of Cardiology, Western University, London Health Sciences Centre, London, Ontario, Canada.
Ann Thorac Surg Short Rep. 2023 Jul 14;1(4):599-603. doi: 10.1016/j.atssr.2023.06.009. eCollection 2023 Dec.
The objective of this study was to report the 5-year outcomes of hybrid arch frozen elephant trunk (FET) procedures with a multibranched hybrid graft.
Between 2014 and 2020, 50 consecutive patients (63 ± 15 years old; 34% women) underwent hybrid arch FET with Thoraflex hybrid graft (Terumo Aortic) at a single center. Indications included aortic aneurysm (n = 48 [96%]), acute aortic dissection (n = 10 [20%]), and chronic dissection (n = 20 [40%]). Follow-up was complete, and mean follow-up was 1455 ± 664 days.
All 50 patients experienced successful device implantation. The 30-day/in-hospital mortality was 2% (n = 1). Stroke and transient neurologic deficits occurred in 1 patient (2%) and 3 patients (6%). Two patients (4%) and 1 patient (2%) experienced transient and permanent spinal cord ischemia. FET thromboembolic complication was observed in 1 patient (2%). In follow-up, 6 patients died of aortic events, and there were 13 reinterventions in the downstream aorta, of which 46% (6/13) were planned second-stage operations. Survival rate at 1 year, 2 years, and 5 years was 96%, 92%, and 85%, and freedom from unplanned distal reintervention at 1 year, 2 years, and 5 years was 98%, 92%, and 81%. Computed tomography follow-up demonstrated positive distal aortic remodeling with aneurysmal regression and stabilized aortic dimensions in patients with aortic dissection.
The hybrid arch FET procedure with a novel hybrid graft is associated with good early and midterm outcomes. Longer term outcomes merit further investigation.
本研究的目的是报告采用多分支杂交移植物的杂交主动脉弓冷冻象鼻术（FET）的5年结果。
2014年至2020年期间，50例连续患者（年龄63±15岁；34%为女性）在单一中心接受了使用Thoraflex杂交移植物（泰尔茂主动脉）的杂交主动脉弓FET手术。适应证包括主动脉瘤（n = 48 [96%]）、急性主动脉夹层（n = 10 [20%]）和慢性夹层（n = 20 [40%]）。随访完整，平均随访时间为1455±664天。
所有50例患者均成功植入器械。30天/住院死亡率为2%（n = 1）。1例患者（2%）发生中风，3例患者（6%）出现短暂性神经功能缺损。2例患者（4%）和1例患者（2%）出现短暂性和永久性脊髓缺血。观察到1例患者（2%）发生FET血栓栓塞并发症。随访中，6例患者死于主动脉相关事件，下游主动脉有13次再次干预，其中46%（6/13）为计划性二期手术。1年、2年和5年的生存率分别为96%、92%和85%，1年、2年和5年无计划的远端再次干预率分别为98%、92%和81%。计算机断层扫描随访显示，主动脉夹层患者的远端主动脉呈阳性重塑，动脉瘤消退，主动脉尺寸稳定。
采用新型杂交移植物的杂交主动脉弓FET手术具有良好的早期和中期结果。长期结果值得进一步研究。
