新型单支主动脉支架移植物治疗 B 型主动脉夹层的疗效。

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2024-09-12 DOI:10.1016/j.athoracsur.2024.07.053

Nimesh D. Desai MD, PhD , Grace J. Wang MD , William Brinkman MD , Joseph Coselli MD , Bradley Taylor MD , Himanshu Patel MD , Michael Dake MD , Fernando Fleischman MD , Jean Panneton MD , Jon Matsumura MD , Matthew Sweet MD , Randall DeMartino MD , Bradley Leshnower MD , Luis Sanchez MD , Joseph E. Bavaria MD

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引用次数: 0

摘要

背景：对 B 型夹层的介入治疗经常需要将支架移植物的近端降落在左侧颈总动脉和左侧锁骨下动脉（LSA）之间。戈尔® TAG® 胸支内支架（TBE）是一种可通过单一内部分支保留 LSA 的技术：本研究是一项前瞻性非随机单臂临床试验，对象是使用单支装置治疗的 B 型主动脉夹层患者。有手术指征的急性、慢性或残余 B 型主动脉夹层患者均符合研究条件，这些患者的左锁骨下动脉起源远端适合分支移植。原生主动脉和手术移植物近端着床区均符合条件：在 132 名患者中，有 25 人（18.9%）为急性 B 型夹层，79 人（59.8%）为慢性 B 型夹层，28 人（21.1%）为 A 型开放式修复后的残余夹层。105例（79.5%）患者采用了经皮入路手术。总体而言，6 名患者（4.5%）在 30 天内死亡。30 天内中风总发生率为 2/132（1.5%），一年内无中风发生率为 96.8%。129/132（97.7%）和 110/132（83.3%）的受试者分别获得了设备技术成功和手术成功，有一例侧支失通。没有观察到持续的前向假腔流：在这项对接受 TEVAR 的 B 型夹层患者进行的保留 LSA 的新型支路内移植装置的研究中，我们证明了一年后的安全性和有效性都是可以接受的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Outcomes of a Novel Single-Branched Aortic Stent Graft for Treatment of Type B Aortic Dissection

Background

Intervention on type B dissection frequently requires landing the proximal edge of the stent graft between the left common carotid artery and left subclavian artery (LSA). The GORE TAG thoracic branch endoprosthesis is a technology that allows LSA preservation with a single internal branch.

Methods

This study was a prospective nonrandomized single-arm clinical trial of patients with type B aortic dissection who were treated with the single-branched device. Patients with operative indications for acute, chronic, or residual type B dissections that originated distal to the origin of an LSA suitable for branch graft placement were eligible for the study. Native aortic and surgical graft proximal landing zones were eligible.

Results

Of the 132 patients, there were 25 (18.9%) acute type B dissections, 79 (59.8%) chronic type B dissections, and 28 (21.1%) residual dissections after previous open type A repair. Percutaneous access was used in 105 (79.5%) patients. Overall, 30-day mortality occurred in 6 patients (4.5%). The overall 30-day stroke rate was 2 of 132 (1.5%), and the 1-year freedom from stroke was 96.8%. Device technical success and procedural success were achieved in 129 of 132 (97.7%) and 110 of 132 (83.3%) patients, respectively, and there was 1 instance of loss of side branch patency. No persistent antegrade false lumen flow was observed.

Conclusions

In this study of a novel branched endograft device to preserve the LSA in patients with type B dissection undergoing thoracic endovascular aortic repair, we demonstrate acceptable safety and efficacy outcomes at 1 year.

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.