PDF(Pubmed)
Abstract：
BACKGROUND: This study aimed to elucidate the methodology and assess the efficacy of the aortic arch inclusion technique using an artificial blood vessel in managing acute type A aortic dissection (ATAAD).
METHODS: We conducted a retrospective review of 18 patients (11 males and 7 females, average age: 56.2 ± 8.6 years) diagnosed with ATAAD who underwent total aortic arch replacement (TAAR) using an artificial vascular \"inclusion\" between June 2020 and October 2022. During the operation, deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (ACP) of the right axillary artery were employed for brain protection. The \'inclusion\' total aortic arch replacement and stented elephant trunk (SET) surgery were performed.
RESULTS: Four patients underwent the Bentall procedure during the study, with one additional patient requiring coronary artery bypass grafting (CABG) due to significant involvement of the right coronary orifice. Three patients died during postoperative hospitalization. Other notable complications included two cases of postoperative renal failure necessitating continuous renal replacement therapy (CRRT), one case of postoperative double lower limb paraplegia, and one case of cerebral infarction resulting in unilateral impairment of the left upper limb. Eleven patients underwent computed tomography angiography (CTA) examinations of the aorta three months to one-year post-operation. The CTA results revealed thrombosis in the false lumen surrounding the aortic arch stent in seven patients and complete thrombosis of the false lumen around the descending aortic stent in eight patients. One patient had partial thrombosis of the false lumen around the descending aortic stent, and another patient\'s false lumen in the thoracic and abdominal aorta completely resolved after one year of follow-up.
CONCLUSIONS: Incorporating vascular graft in aortic arch replacement simplifies the procedure and yields promising short-term outcomes. It achieves the aim of total arch replacement using a four-branch prosthetic graft. However, extensive sampling and thorough, prolonged follow-up observations are essential to fully evaluate the long-term results.
METHODS: We conducted a retrospective review of 18 patients (11 males and 7 females, average age: 56.2 ± 8.6 years) diagnosed with ATAAD who underwent total aortic arch replacement (TAAR) using an artificial vascular \"inclusion\" between June 2020 and October 2022. During the operation, deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (ACP) of the right axillary artery were employed for brain protection. The \'inclusion\' total aortic arch replacement and stented elephant trunk (SET) surgery were performed.
RESULTS: Four patients underwent the Bentall procedure during the study, with one additional patient requiring coronary artery bypass grafting (CABG) due to significant involvement of the right coronary orifice. Three patients died during postoperative hospitalization. Other notable complications included two cases of postoperative renal failure necessitating continuous renal replacement therapy (CRRT), one case of postoperative double lower limb paraplegia, and one case of cerebral infarction resulting in unilateral impairment of the left upper limb. Eleven patients underwent computed tomography angiography (CTA) examinations of the aorta three months to one-year post-operation. The CTA results revealed thrombosis in the false lumen surrounding the aortic arch stent in seven patients and complete thrombosis of the false lumen around the descending aortic stent in eight patients. One patient had partial thrombosis of the false lumen around the descending aortic stent, and another patient\'s false lumen in the thoracic and abdominal aorta completely resolved after one year of follow-up.
CONCLUSIONS: Incorporating vascular graft in aortic arch replacement simplifies the procedure and yields promising short-term outcomes. It achieves the aim of total arch replacement using a four-branch prosthetic graft. However, extensive sampling and thorough, prolonged follow-up observations are essential to fully evaluate the long-term results.
摘要：
背景：本研究旨在阐明采用人工血管的主动脉弓包合技术治疗急性A型主动脉夹层（ATAAD）的方法学和疗效评估。
方法：我们对18例患者（男11例，女7例，平均年龄：56.2±8.6岁），在2020年6月至2022年10月期间，诊断为ATAAD，并使用人工血管“纳入物”进行了全主动脉弓置换术（TAAR）。在操作过程中,采用深低温停循环（DHCA）和右腋窝动脉选择性顺行脑灌注（ACP）进行脑保护。进行了“包含”全主动脉弓置换和支架象鼻（SET）手术。
结果：研究期间有4名患者接受了Bentall手术，另外一名患者由于右冠孔严重受累而需要冠状动脉旁路移植术（CABG）。3例患者在术后住院期间死亡。其他值得注意的并发症包括2例术后肾功能衰竭，需要连续肾脏替代疗法（CRRT）。术后双下肢截瘫1例,1例脑梗塞导致左上肢单侧损伤。术后三个月至一年，对11例患者进行了主动脉计算机断层扫描血管造影（CTA）检查。CTA结果显示7例患者主动脉弓支架周围的假腔血栓形成，8例患者降主动脉支架周围的假腔完全血栓形成。一名患者在降主动脉支架周围的假腔部分血栓形成，随访一年后，另一名患者的胸主动脉和腹主动脉假腔完全消退。
结论：在主动脉弓置换中合并血管移植物可简化手术并产生有希望的短期结果。它使用四分支假体移植物实现了全足弓置换的目的。然而,广泛的采样和彻底的，长期随访观察对于全面评估长期结果至关重要.
方法：我们对18例患者（男11例，女7例，平均年龄：56.2±8.6岁），在2020年6月至2022年10月期间，诊断为ATAAD，并使用人工血管“纳入物”进行了全主动脉弓置换术（TAAR）。在操作过程中,采用深低温停循环（DHCA）和右腋窝动脉选择性顺行脑灌注（ACP）进行脑保护。进行了“包含”全主动脉弓置换和支架象鼻（SET）手术。
结果：研究期间有4名患者接受了Bentall手术，另外一名患者由于右冠孔严重受累而需要冠状动脉旁路移植术（CABG）。3例患者在术后住院期间死亡。其他值得注意的并发症包括2例术后肾功能衰竭，需要连续肾脏替代疗法（CRRT）。术后双下肢截瘫1例,1例脑梗塞导致左上肢单侧损伤。术后三个月至一年，对11例患者进行了主动脉计算机断层扫描血管造影（CTA）检查。CTA结果显示7例患者主动脉弓支架周围的假腔血栓形成，8例患者降主动脉支架周围的假腔完全血栓形成。一名患者在降主动脉支架周围的假腔部分血栓形成，随访一年后，另一名患者的胸主动脉和腹主动脉假腔完全消退。
结论：在主动脉弓置换中合并血管移植物可简化手术并产生有希望的短期结果。它使用四分支假体移植物实现了全足弓置换的目的。然而,广泛的采样和彻底的，长期随访观察对于全面评估长期结果至关重要.
