升主动脉术后吻合口瘘经导管封堵的中期结果。

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cheng-Wei Yang, Wei-Guo Ma, Hao Liu, Xin Li, Ming-Liang Peng, Lian-Jun Huang, Li-Zhong Sun
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引用次数: 0

摘要

目的:评价升主动脉(AAo)术后经导管封堵吻合口漏(AL)的安全性和持久性。方法:2016-2021年,我们对22例年龄56.9±12岁的AAoAL患者(男性19例,占86.4%)在AAo手术后行经导管闭合。根据Cabrol(左心房至右心房)分流(n=16, 72.7%)和泄漏大小选择通路和设备。结果:三尖瓣反流15例(68.2%);有症状的13例(59.1%),NYHA功能III/IV级11例(50%)。平均AAoAL直径3.3±1.5mm。平均手术时间141±53min。手术成功率为86.4% (Cabrol分流19/ 22,14)。12例AAoAL直接闭合或卷曲。随访率100%,平均4.9±1.1年(范围3.6-8.1年)。所有患者均存活,其中2例再次手术。术后2年死亡和再手术率为94.7%,术后7年为89.5%。11例AAoAL完全消失,8例可见微量残留分流。漏处主动脉均明显缩小(49.1 ~ 41.4mm, P=0.010)。Cabrol分流术患者右心房收缩(46.9±8.8 vs 39.1±8.2mm, P=0.030)、右心室收缩(41.4±4.7 vs 30.4±6.2mm)显著。结论:经导管封堵是一种可行、安全、有效的方法,在部分患者中可获得较好的中短期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Midterm Outcomes of Transcatheter Closure of Anastomotic Leak after Ascending Aortic Surgery.

This study aimed to evaluate the safety and durability of transcatheter closure of anastomotic leak (AL) after ascending aortic (AAo) surgery.From 2016 to 2021, we performed transcatheter closure for 22 patients aged 56.9 ± 12 years (19 male, 86.4%) who sustained anastomotic leak in the ascending aorta (AAoAL) after AAo surgery. Access and device were selected according to the presence of a patent Cabrol (perigraft-to-right atrium [RA]) shunt (n = 16, 72.7%) and leak size.Fifteen patients had tricuspid regurgitation (TR; 68.2%), 13 were symptomatic (59.1%), and 11 were in the New York Heart Association (NYHA) functional class III/IV (50%). Mean AAoAL diameter was 3.3 ± 1.5 mm. Mean procedural time was 141 ± 53 minutes. Procedural success rate was 86.4% (19/22, 14 with Cabrol shunt). AAoAL was directly closed or coiled in 12 patients. Follow-up was complete in 100% at a mean duration of 4.9 ± 1.1 years (range 3.6-8.1). All patients were alive, and two underwent reoperation. Freedom from death and reoperation was 94.7% at 2 years and 89.5% through 8 years. AAoAL was obliterated in 11, while a trace residual shunt was seen in 8 patients. The aorta at the leak shrank significantly in all (49.1-41.4 mm, p = 0.010). Patients with Cabrol shunt showed a significant shrinkage of the RA (46.9 ± 8.8 mm vs. 39.1 ± 8.2 mm, p = 0.030) and right ventricle (41.4 ± 4.7 mm vs. 30.4 ± 6.2 mm, p < 0.001), along with improved heart function (NHYA class III 4/12, IV 5/12 vs. class III 4/12, IV 0/12, p = 0.032) and alleviation of TR (moderate 6/14, severe 3/14 vs. moderate 2/14, severe 1/14, p = 0.081).Transcatheter closure may be a feasible, safe, and effective approach to anastomotic leak after ascending aortic surgery in selected patients, which can achieve favorable short- to midterm outcomes.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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