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首页> 外文期刊>The Annals of Thoracic Surgery: Official Journal of the Society of Thoracic Surgeons and the Southern Thoracic Surgical Association >Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection
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Ascending Aorta and Hemiarch Replacement Combined With Modified Triple-Branched Stent Graft Implantation for Repair of Acute DeBakey Type I Aortic Dissection

机译：升主动脉和半主动脉置换联合改良三分支支架植入物修复急性DeBakey I型主动脉夹层

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摘要

Background To simplify extensive repair of acute DeBakey type I aortic dissection, ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation was developed. The descriptions and early results of this technique are reported.;Methods From August 2014 to September 2015, 116 patients with acute DeBakey type I aortic dissection underwent ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation. Clinical data of all patients were retrospectively reviewed. Survivors were followed up prospectively by computed tomography angiography.;Results The cardiopulmonary bypass time was 131.5 ± 10.7 minutes, the aortic cross-clamp time was 50.0 ± 9.9 minutes, and the selective cerebral perfusion and lower body arrest time was 17.2 ± 2.2 minutes. The in-hospital mortality rate was 3.4%. Two patients were lost during follow-up. One patient died of a cerebrovascular accident 2 months after discharge, and another died of chronic renal failure 5 months after discharge. At the 3-month postoperative scans, complete thrombus formation of the false lumen around the implanted modified triple-branched stent graft occurred in all survivors, at the diaphragmatic level in 69.7% patients, and at the superior mesenteric arterial level in 8.3% patients.;Conclusions Extensive thoracic aorta repair of acute type I aortic dissection can be performed simply by combining ascending aorta and hemiarch replacement with modified triple-branched stent graft implantation. This technique can reduce the risk and technical difficulty of extensive thoracic aorta repair to levels close to those seen with ascending aorta and hemiarch graft replacement with open distal anastomosis.;Ascending aorta replacement combined with open triple-branched stent graft implantation was performed by our group for repair of acute type I aortic dissection [1, 2]. This open triple-branched stent graft implantation technique provides effective extensive repair without increasing the risk to the patient [3, 4, 5, 6]. In this technique, the native aortic arch is totally preserved, and consequently the stent graft implantation is performed through the distal ascending transection and in the limited space inside the native aortic arch [1, 2, 3, 4, 5, 6]. The key point of successful implantation is that the aortic arch vessel orifices and the true lumen of the descending aorta should be clearly identified. Unfortunately, the aortic arch vessel orifices and the true lumen of the descending aorta could not be clearly seen through the distal ascending incision in some of our cases, and this resulted in difficult implantation of the triple-branched stent graft [6, 7]. To facilitate exposure of the aortic arch vessel orifices and the true lumen of the descending aorta, an arch open and closed technique has been recommended [8, 9]. Performing this open and closed procedure at the dissected aortic arch increases the selective cerebral perfusion and lower body arrest time and may result in intraoperative or postoperative hemorrhage secondary to tissue tearing at the suture line. To reduce the potential for such a problem, we modified this open triple-branched stent graft implantation technique to a simpler and safer procedure: ascending aorta and hemiarch replacement combined with modified triple-branched stent graft implantation. Here we describe our modified technique and report the initial results in 116 patients.Jump to SectionPatients and MethodsPatient PopulationModified Triple-Branched Stent GraftSurgical ProcedureData Collection and Follow-UpPostoperative Neurologic Dysfunction EvaluationResultsOperative DataEarly Mortality and MorbidityFollow-UpCommentReferences;The ethics committee of our institution, Union Hospital of Fujian Medical University in Fuzhou, China, approved this study protocol, and we obtained preoperative informed consent from each patient or the patient’s legal representative.Jump to SectionPa
机译：背景技术为了简化急性DeBakey I型主动脉夹层的广泛修复，开发了升主动脉和半主动脉置换结合改良的三支支架植入物植入术。方法2014年8月至2015年9月，对116例急性DeBakey I型主动脉夹层患者行升主动脉和半主动脉置换联合改良三支支架植入术。回顾性分析所有患者的临床资料。结果：计算机断层血管造影术对幸存者进行了随访。结果：心肺旁路时间为131.5±10.7分钟，主动脉夹钳时间为50.0±9.9分钟，选择性脑灌注和下半身停搏时间为17.2±2.2分钟。住院死亡率为3.4％。两名患者在随访中丢失。一名患者出院后两个月死于脑血管意外，另一名患者出院后五个月死于慢性肾衰竭。在术后三个月的扫描中，在所有幸存者中，植入的改良三支支架移植物周围完全形成了假的内腔血栓，在diaphragm肌水平为69.7％，在肠系膜上动脉为8.3％。结论急性I型主动脉夹层的胸主动脉修复可以简单地通过将升主动脉和半主动脉置换与改良的三支支架植入物结合起来进行。该技术可将广泛的胸主动脉修复风险降低至技术水平，使其接近于升主动脉和半开放式远端吻合术替代半主动脉移植所见的水平;本组进行升主动脉置换联合开放式三支支架植入术修复急性I型主动脉夹层[1，2]。这种开放式三支支架植入物植入技术可提供有效的广泛修复，而不会增加患者的风险[3、4、5、6]。在该技术中，天然主动脉弓被完全保留，因此支架移植物植入是通过远端上升横切并在天然主动脉弓内部的有限空间内进行的[1,2,3,4,5,6]。成功植入的关键是应明确识别主动脉弓血管孔和降主动脉的真实腔。不幸的是，在我们的某些病例中，无法通过远端上升切口清晰地看到主动脉弓血管孔和降主动脉的真实腔，这导致三支支架植入物难以植入[6，7]。为了促进主动脉弓血管孔和降主动脉真实管腔的暴露，建议使用弓开放和闭合技术[8，9]。在解剖的主动脉弓上执行此打开和关闭过程会增加选择性脑灌注并降低下肢停止时间，并且可能会由于缝合线组织撕裂而导致术中或术后出血。为了减少发生此问题的可能性，我们将这种开放式三支支架移植物植入技术修改为更简单和更安全的过程：升主动脉和半主动脉置换结合改良的三支支架植入物植入。此处介绍了我们改良的技术并报告了116例患者的初步结果。跳转至患者和方法患者人群改良的三分叉支架移植物的外科手术程序数据收集和随访术后神经功能障碍评估结果操作数据早期死亡率和发病率后续评论参考;本机构伦理委员会中国福州福建医科大学附属医院批准了本研究方案，并获得了每位患者或患者法定代表人的术前知情同意。

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