Ma Xiantao, Zhu Zhangqiang, Feng Yi, Li Chenhe, Hou Ningxin, Cheng Cai
Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
JTCVS Tech. 2025 Mar 8;31:11-17. doi: 10.1016/j.xjtc.2025.03.002. eCollection 2025 Jun.
The aim of this retrospective single-center study was to report a novel hybrid technique of replacement of the ascending aorta and implantation of fenestrated stent-graft of the entire aortic arch for Stanford type A aortic dissection and to analyze clinical experience and outcomes.
From January 2019 to January 2023 in Tongji hospital, 31 cases (26 men and 5 women, mean age 56.06 ± 10.34 years) with Stanford type A aortic dissection underwent open ascending aorta replacement combined with total endovascular arch repair. All patients underwent ascending aorta replacement without hypothermia or circulatory arrest. Arch intervention was performed with self-modified stent-grafts to preserve the aortic arch native branches.
The surgical technical success rate was 100% in all patients. One (3.22%) patient died after surgery due to cerebral hemorrhage. Five (16.13%) patients with preoperative renal insufficiency required hemodialysis. Six (19.36%) patients were on mechanical ventilation for more than 48 hours. One patient was found to have an endoleak (Type IV). There were 25 (83.33%) patients who underwent follow-up with a median follow-up time of 14.00 months (range, 6.50-28.50 months). Two (8.00%) of them died (1 of infectious shock and the other of respiratory arrest) and 2 (8.00%) underwent aortic reoperation.
Single-stage open ascending aortic replacement combined with the total aortic endovascular arch intervention may provide satisfactory early outcomes in Stanford type A aortic dissection. This strategy may be valuable for a subgroup of patients deemed inappropriate candidates for open classic full arch repair.
本回顾性单中心研究旨在报告一种用于斯坦福A型主动脉夹层的升主动脉置换及全主动脉弓开窗支架型人工血管植入的新型杂交技术，并分析临床经验及结果。
2019年1月至2023年1月期间，在同济医院，31例（26例男性和5例女性，平均年龄56.06±10.34岁）斯坦福A型主动脉夹层患者接受了升主动脉开放置换联合全主动脉弓腔内修复术。所有患者均在无低温或循环停止的情况下进行升主动脉置换。采用自行改良的支架型人工血管进行弓部干预，以保留主动脉弓的原位分支。
所有患者手术技术成功率均为100%。1例（3.22%）患者术后因脑出血死亡。5例（16.13%）术前存在肾功能不全的患者需要进行血液透析。6例（19.36%）患者机械通气时间超过48小时。1例患者发现有内漏（IV型）。25例（83.33%）患者接受了随访，中位随访时间为14.00个月（范围6.50 - 28.50个月）。其中2例（8.00%）死亡（1例死于感染性休克，另1例死于呼吸骤停），2例（8.00%）接受了主动脉再次手术。
单阶段升主动脉开放置换联合全主动脉弓腔内干预在斯坦福A型主动脉夹层中可能提供满意的早期结果。该策略对于被认为不适合进行经典开放全弓修复的部分患者亚组可能具有价值。
