Shah Aakash, Leibowitz Joshua, Lu Jeffrey, Tran Douglas, Stallings Julia, Toursavadkohi Shahab, Taylor Bradley, Ghoreishi Mehrdad
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, 21201, United States.
Department of Surgery, Baptist Health, Miami, FL, 33176, United States.
Interdiscip Cardiovasc Thorac Surg. 2025 Jul 3;40(7). doi: 10.1093/icvts/ivaf164.
This study aims to evaluate the short-term outcomes of total arch replacement using 2 techniques: the branched stented anastomosis frozen elephant trunk repair (B-SAFER) under moderate hypothermia (25-28 °C), and a simplified total arch and hybrid arch frozen elephant trunk (HA-FET) reconstruction using the Thoraflex stent graft under mild hypothermia (>32 °C).
Sixty-one patients underwent total arch replacement between June 2020 and March 2024. 25 received HA-FET, and 36 received B-SAFER. Central cannulation and cerebral debranching of the innominate and left common carotid arteries were performed before circulatory arrest in both groups. Axillary cannulation led to debranching after circulatory arrest. In the HA-FET group, snares were placed circumferentially in zone 1 and zone 2 prior to circulatory arrest and deployment of FET graft; in B-SAFER, antegrade thoracic stent graft was deployed in zone 2 with left subclavian fenestration and stenting.
Mean age 57.4 ± 13.1 years, with 74% male. Acute type A was the pathology in 60% of HA-FET and 58% of B-SAFER patients. HA-FET had significantly shorter circulatory arrest times (9 vs 40 minutes, P < .001) but similar cardiopulmonary bypass and cross-clamp times. The rate of concomitant major cardiac procedure was higher in HA-FET group (13/25, 52% vs 10/36, 27%, P = .066). Neurologic dysfunction (4% vs 5.4%, P = 1) and in-hospital mortality (4% vs 8.1%, P = .64) were similar. No paraplegia occurred, and renal failure requiring dialysis occurred in 12% of HA-FET and 8.1% of B-SAFER patients (P = .68).
Both mild hypothermic total arch with hybrid FET repair and hypothermic total arch replacement utilizing B-SAFER technique provide safe and favourable short-term outcomes. Further studies with larger cohorts and long-term follow-up are required.
本研究旨在评估两种技术进行全弓置换的短期结果：中度低温（25 - 28°C）下的分支带支架吻合冷冻象鼻修复术（B - SAFER），以及轻度低温（>32°C）下使用Thoraflex支架移植物进行的简化全弓和杂交弓冷冻象鼻（HA - FET）重建术。
2020年6月至2024年3月期间，61例患者接受了全弓置换术。25例接受HA - FET，36例接受B - SAFER。两组均在循环停止前进行中心插管以及无名动脉和左颈总动脉的脑去分支。腋动脉插管在循环停止后进行去分支。在HA - FET组中，在循环停止和FET移植物展开之前，在1区和2区周向放置圈套器；在B - SAFER组中，在2区进行顺行性胸主动脉支架移植物植入并伴有左锁骨下动脉开窗和支架置入。
平均年龄57.4±13.1岁，男性占74%。HA - FET组60%的患者和B - SAFER组58%的患者病因是急性A型主动脉夹层。HA - FET组的循环停止时间明显更短（9分钟对40分钟，P <.001），但体外循环和主动脉阻断时间相似。HA - FET组同期进行主要心脏手术的比例更高（13/25，52%对10/36，27%，P = 0.066）。神经功能障碍（4%对5.4%，P = 1）和住院死亡率（4%对8.1%，P = .64）相似。未发生截瘫，HA - FET组12%的患者和B - SAFER组8.1%的患者出现需要透析的肾衰竭（P = .68）。
轻度低温下的杂交FET全弓修复术和使用B - SAFER技术的低温全弓置换术均能提供安全且良好的短期结果。需要进行更大样本队列和长期随访的进一步研究。
