Bojko Markian M, Oslund William, Kirsch Michael J, Carroll Adam M, Longo Emma, Clothier Jessica S, Okonkwo Kamso, Rajeev Nithya, Dhanekula Arjune, McCarthy Fenton, Cafarelli Anthony, Glotzbach Jason, Burke Christopher R, Reece T Brett, Kobsa Serge, Fleischman Fernando
Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, Calif.
Department of Surgery, University of Colorado, Denver, Colo.
JTCVS Open. 2024 Nov 8;23:19-33. doi: 10.1016/j.xjon.2024.10.027. eCollection 2025 Feb.
Traditional total arch replacement with frozen elephant trunk requires 2 separate grafts in the descending thoracic aorta and arch, and frequently requires a graft-to-graft anastomosis, which is prone to bleeding. The Thoraflex (Terumo Aortic) device treats the arch and descending thoracic aorta in a single device but has not been compared directly to traditional total arch replacement with frozen elephant trunk and has not been studied in a real-world context in the United States.
A consecutive sample of total arch replacement with frozen elephant trunk patients across 5 different institutions between January 2018 and January 2024, identified 438 patients of which 83 out of 438 (18.9%) had a Thoraflex device. Propensity score matching in a 1:2 ratio identified 166 well-matched controls. Groups were compared across perioperative outcomes.
One hundred forty out of 438 (32%) patients presented with acute type A dissection, 112 out of 438 (26%) had an aneurysm, and 87 out of 438 (20%) had chronic dissection with a previous proximal repair. One hundred thirty-two out of 438 (30%) underwent surgery on an emergency or emergency/salvage basis. Median (interquartile range [IQR]) crossclamp times in the Thoraflex and traditional matched groups were 71 (IQR, 48-105) and 82 (IQR, 62-123), respectively, ( = .012). Total circulatory arrest times were 19 minutes (IQR, 13-32 minutes) and 23 minutes (IQR, 17-37 minutes), respectively ( = .009). Total procedure times were 6.1 hours (IQR, 5.2-7.3 hours) and 6.8 hours (IQR, 5.7-8.2 hours), respectively ( = .012). The operative mortality, stroke, and paralysis rates were 11 out of 83 (13%), 16 out of 83 (19%), and 4 out of 83 (5%), respectively, in the Thoraflex group and were not significantly different than matched controls.
The Thoraflex hybrid device facilitates shorter crossclamp and circulatory arrest times for arch replacement, with similar observed mortality and stroke rates compared with matched controls.
传统的带冷冻象鼻的全弓置换术需要在降主动脉和主动脉弓中使用2个单独的移植物，并且经常需要进行移植物与移植物的吻合，这容易出血。Thoraflex（泰尔茂主动脉）装置在一个装置中治疗主动脉弓和降主动脉，但尚未与传统的带冷冻象鼻的全弓置换术进行直接比较，也未在美国的实际临床环境中进行研究。
对2018年1月至2024年1月期间5个不同机构中接受带冷冻象鼻全弓置换术的患者进行连续抽样，共识别出438例患者，其中438例中的83例（18.9%）使用了Thoraflex装置。以1:2的比例进行倾向得分匹配，确定了166例匹配良好的对照。比较两组的围手术期结局。
438例患者中有140例（32%）表现为急性A型主动脉夹层，438例中有112例（26%）患有动脉瘤，438例中有87例（20%）患有慢性夹层且先前有近端修复。438例中有132例（30%）在急诊或急诊/挽救情况下接受手术。Thoraflex组和传统匹配组的中位（四分位间距[IQR]）阻断时间分别为71（IQR，48 - 105）和82（IQR，62 - 123）（P = 0.012）。总循环阻断时间分别为19分钟（IQR，13 - 32分钟）和23分钟（IQR，17 - 37分钟）（P = 0.009）。总手术时间分别为6.1小时（IQR，5.2 - 7.3小时）和6.8小时（IQR，5.7 - 8.2小时）（P = 0.012）。Thoraflex组的手术死亡率、中风率和瘫痪率分别为83例中的11例（13%）、83例中的16例（19%）和83例中的4例（5%），与匹配的对照组无显著差异。
Thoraflex混合装置有助于缩短全弓置换术的阻断和循环阻断时间，与匹配的对照组相比，观察到的死亡率和中风率相似。
