■A型急性夹层(AAD)手术修复后主动脉弓的残留病理的治疗代表了治疗挑战。最近,新的分支血管内装置扩大了主动脉弓支架移植术(ASG)在0区近端着陆的可能性。这次回顾的目的,单中心研究旨在评估有AAD手术修复史的患者在使用分支装置进行ASG时的结局.
■我们分析了使用2种不同分支设备进行AAD类型治疗后接受ASG的患者:Nexus(双模块,单分支,现成的)和RelayBranch(单模块,双分支,定制)。在ASG之前,根据患者的解剖结构和所选择的装置进行主动脉上血管的外科搭桥。所有患者在出院前均接受临床和计算机断层扫描评估,6个月时,此后每年一次。
■从2017年3月至2019年4月,我们机构连续4名患者在AAD手术后接受了ASG治疗。从AAD手术到ASG的平均时间为20个月。ASG时的平均年龄为72岁。Nexus和Relay分别植入2例患者。所有患者均存活并顺利出院。平均重症监护室住院时间和住院时间分别为3天和19天,分别。我们没有观察到任何重大不良事件。平均随访28个月,所有患者均存活,计算机断层扫描显示良好的解剖结果,无内漏.
■此初步经验表明,AAD手术后ASG是可行的,并提供了令人鼓舞的临床和解剖早期结果。
UNASSIGNED: The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices.
UNASSIGNED: We analyzed patients undergoing ASG after treatment for type AAD with 2 different branched devices: Nexus (dual-module, single branch, off-the-shelf) and RelayBranch (single-module, dual branch, custom-made). Before ASG, surgical bypass of supra-aortic vessels was performed according to patient\'s anatomy and to the selected device. All patients underwent clinical and computed tomography scan evaluation before hospital discharge, at 6 months, and on a yearly basis thereafter.
UNASSIGNED: From March 2017 to April 2019, 4 consecutive patients underwent ASG after surgery for AAD at our institution. Mean time from surgery for AAD to ASG was 20 months. Mean age at the time of ASG was 72 years. Nexus and Relay were implanted in 2 patients each. All patients survived and were successfully discharged. Mean intensive care unit stay and hospital stay were 3 and 19 days, respectively. We did not observe any major adverse events. At a mean follow-up of 28 months, all patients are alive and computed tomography scans showed good anatomic results with no endoleaks.
UNASSIGNED: This preliminary experience shows that ASG after surgery for AAD is feasible and provides encouraging clinical and anatomic early results.