Arakawa Mamoru, Kawahito Koji
Department of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3). doi: 10.1093/icvts/ivaf044.
Thoracic endovascular aortic repair is widely performed in complicated and uncomplicated type B aortic dissection cases. After the introduction of a stent graft, the use of several types of hybrid approaches has been reported for patients with type A aortic dissection. The procedure is advanced because the complications are fatal; therefore, training is required. However, the surgical simulation of aortic dissection is challenging because no favourable animal model is available. This study aimed to simulate hybrid surgical simulation using a novel three-dimensional aortic dissection model. Three-dimensional polyurethane models of type A and B aortic dissection, both of which have true and false lumens, were manufactured based on computed tomography data. Under fluoroscopy, the entry tear and false lumen flows were visualized using a contrast medium. A stent graft was delivered and deployed under pulsatile conditions in the type B aortic dissection model. Total arch replacement was performed in the type A and B aortic dissection models after thoracic endovascular aortic repair as a hybrid approach. In conclusion, a model with a mock circuit is a useful tool to simulate both open and endovascular aortic repair for aortic dissections as a hybrid approach.
胸主动脉腔内修复术在复杂和非复杂的B型主动脉夹层病例中广泛应用。在引入支架移植物后，有报道称针对A型主动脉夹层患者采用了几种类型的杂交手术方法。该手术进展迅速，因为并发症可能致命；因此需要进行培训。然而，主动脉夹层的手术模拟具有挑战性，因为没有合适的动物模型。本研究旨在使用一种新型三维主动脉夹层模型模拟杂交手术模拟。基于计算机断层扫描数据制作了具有真腔和假腔的A型和B型主动脉夹层的三维聚氨酯模型。在荧光透视下，使用造影剂观察入口撕裂和假腔血流。在B型主动脉夹层模型中，在搏动条件下输送并展开支架移植物。作为杂交手术方法，在胸主动脉腔内修复术后，对A型和B型主动脉夹层模型进行全弓置换。总之，带有模拟回路的模型是一种有用的工具，可作为杂交手术方法模拟主动脉夹层的开放和腔内主动脉修复。
