Chang John Chien-Hwa, Huang Shih-Ming, Hii Ing-Heng, Cheng Chi-Fu, Lu Pei-Chei, Cheng Yi-Tso
Division of Cardiovascular Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan.
Department of Medicine, Tzu Chi University, Hualien, Taiwan.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 29;40(4). doi: 10.1093/icvts/ivaf081.
Hybrid arch repair improved surgical outcomes in aneurysmal disease. Sutureless anastomosis using an intraluminal ringed graft and stent graft bridging has been reported. We incorporate the vascular ring connector, angiography-assisted sutureless telescoping anastomosis technique, and thoracic endovascular aortic repair, rendering the hybrid arch repair for acute type A aortic dissection sutureless. Herein, we presented our sutureless procedure for acute type A aortic dissection.
Between January 2022 and April 2023, 19 patients who underwent sutureless type II hybrid arch repair were enrolled. The surgical procedures were described. The preoperative demographics, operative details, postoperative outcomes and follow-up results were retrospectively collected.
Nineteen patients with a median age of 62 (interquartile range [IQR]: 10.5) and male dominant in 73.7% were recorded. The sutureless type II hybrid arch repair was performed in a median operative time of 397 min (IQR: 111.5), with a cardiopulmonary bypass time of 184 min (IQR: 52.5). The fully sutureless type II hybrid arch repair further reduced the abovementioned times. In-hospital death was two in 10.5%. Seventeen discharged patients had regular follow-ups in a median of 553 days (IQR: 129). The serial computed tomography scan revealed all reconstructed arch vessels were patent, and positive aortic remodelling was observed at the arch and thoracic endoprosthesis levels at 100% and 94.2%, respectively.
Sutureless type II hybrid arch repair is feasible, demonstrating complete procedural success and favourable postoperative outcomes in mid-term follow-up. Long-term monitoring is necessary to assess this procedure's durability and potential complications.
杂交弓修复术改善了动脉瘤性疾病的手术效果。已有报道采用腔内带环移植物和支架移植物桥接的无缝合吻合术。我们采用血管环连接器、血管造影辅助无缝合套叠吻合技术和胸主动脉腔内修复术，使急性A型主动脉夹层的杂交弓修复术实现无缝合。在此，我们介绍了急性A型主动脉夹层的无缝合手术方法。
2022年1月至2023年4月，纳入19例行无缝合II型杂交弓修复术的患者。描述了手术过程。回顾性收集术前人口统计学资料、手术细节、术后结果和随访结果。
记录了19例患者，中位年龄62岁（四分位间距[IQR]：10.5），男性占73.7%。无缝合II型杂交弓修复术的中位手术时间为397分钟（IQR：111.5），体外循环时间为184分钟（IQR：52.5）。完全无缝合II型杂交弓修复术进一步缩短了上述时间。住院死亡率为10.5%，共2例。17例出院患者的中位随访时间为553天（IQR：129）。系列计算机断层扫描显示，所有重建的弓血管均通畅，在弓部和胸段人工血管水平分别观察到100%和94.2%的主动脉正向重塑。
无缝合II型杂交弓修复术是可行的，在中期随访中显示出手术完全成功和良好的术后效果。需要长期监测以评估该手术的耐久性和潜在并发症。
