de Silva Ravi, Quinn Morgan, Nita Ciprian, Purmessur Rushmi, Vokshi Ismail, Farid Shakil, Falter Florian
Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom.
Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
JTCVS Open. 2025 May 20;26:132-137. doi: 10.1016/j.xjon.2025.05.003. eCollection 2025 Aug.
Postoperative intraluminal thrombosis after frozen elephant trunk replacement has been reported to occur with a frequency of 6% to 17% and is associated with poor outcomes. The purpose of this institutional review is to analyze thrombosis rate, predisposing patient and operative factors, and assess different anticoagulation regimens.
This retrospective cohort study includes 174 patients operated on over 10 years. one hundred forty-five of these underwent elective aortic arch replacement; 29 had the procedure for Type A aortic dissection repair.
Sixteen elective (11%) and 3 dissection patients (10%) had radiographic evidence of intraluminal thrombus. There were no statistical differences in demographic or intraoperative characteristics between the 2 groups. Of the 16 elective patients with thrombus, 12 (75%) had aneurysmal disease. Central graft position is associated with a higher incidence of intraluminal thrombus formation than eccentric position in both cohorts, 17% versus 7% in elective patients and 15% versus 0% in the dissection group. Patients with intraluminal thrombosis had significantly lower 6-month survival in both cohorts (69% vs 92% and 66% vs 88%; = .0037) and this was also true for the elective group (69% vs 96%; = .0001). Of several anticoagulation regimens employed over the study period, early introduction of warfarin proved superior.
The incidence of thrombus formation is higher in patients with aneurysmal disease and when the graft is positioned centrally. Early anticoagulation with warfarin appears to be protective. We advocate the creation of a registry to help improve outcomes after this complex surgery.
据报道，冷冻象鼻支架置入术后腔内血栓形成的发生率为6%至17%，且与不良预后相关。本机构回顾性研究的目的是分析血栓形成率、患者易患因素和手术因素，并评估不同的抗凝方案。
这项回顾性队列研究纳入了10年间接受手术的174例患者。其中145例行择期主动脉弓置换术；29例行A型主动脉夹层修复术。
16例（11%）择期手术患者和3例（10%）夹层患者有腔内血栓形成的影像学证据。两组患者的人口统计学或术中特征无统计学差异。在16例有血栓形成的择期手术患者中，12例（75%）患有动脉瘤性疾病。在两个队列中，中心型移植物位置比偏心型移植物位置的腔内血栓形成发生率更高，择期手术患者分别为17%和7%，夹层组分别为15%和0%。两个队列中，有腔内血栓形成的患者6个月生存率显著较低（分别为69%对92%和66%对88%；P = 0.0037），择期手术组也是如此（69%对96%；P = 0.0001）。在研究期间采用的几种抗凝方案中，早期应用华法林效果更佳。
动脉瘤性疾病患者以及移植物为中心型位置时，血栓形成的发生率更高。早期应用华法林抗凝似乎具有保护作用。我们提倡建立一个登记系统，以帮助改善这种复杂手术后的预后。
