摘要
主动脉弓去分支化术(Aortic arch debranching,AAD)作为全弓置换的替代方案,正逐渐被运用于高危患者中。在主动脉弓部瘤的患者中,联合去分支化及胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)的杂交技术可降低75岁以上患者的住院死亡率。在B型主动脉夹层中,去分支化术可提供稳定的近端锚定区,避免烟囱及开窗技术所带来的手术难度,且有助减少内漏的发生。在A型主动脉夹层中,去分支化术主要有三种应用方式:预防性的行去分支化术,以为远期弓部的再次干预提供稳定近端锚定区;行升主动脉置换+主动脉弓去分支化+TEVAR术,可在无深低温停循环的条件下完成弓部修复;在全弓置换中,优先行弓部去分支化术,可降低停循环的温度要求及持续时间。主动脉弓去分支化术既可作为替代性的手术方式,也可作为传统全弓置换的改进方向,以改善患者的生存率。
Aortic arch debranching(AAD) is increasingly being used in high-risk patients as an alternative to total arch replacement. In patients with aortic arch aneurysm, the hybrid, combining debranching and TEVAR,can reduce in-hospital mortality in patients over 75 years of age. To type B aortic dissection, the debranching can provide a stable proximal landing zone, avoid the difficulty brought by chimney or fenestration technique, and help to reduce endoleaks. To type A aortic dissection, there are three main applications of the debranching: preventive debranching to provide a stable proximal landing zone for further intervention of the arch;ascending aorta replacement + AAD + TEVAR can complete arch repair without deep hypothermic circulatory arrest;For total arch replacement, the priority of arch debranching can reduce the temperature requirement and duration of deep hypothermic circulatory arrest. AAD can be used as an alternative surgical method and an improvement direction of traditional total arch replacement to improve the survival rate.
作者
崔伟明
李庆国
CUI Wei-ming;LI Qing-guo(Department of Cardiovascular Center,The Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)
出处
《中国心血管病研究》
CAS
2021年第8期702-706,共5页
Chinese Journal of Cardiovascular Research
关键词
去分支化
主动脉夹层
深低温停循环
杂交手术
Debranching
Aortic dissection
Deep hypothermic circulatory arrest
Hybrid
