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Fontus术中支架在急性A型主动脉夹层中的应用

The study on the safety and efficiency of Fontus frozen elephant trunk in patients with type A acute aortic dissection
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摘要 目的探讨Fontus术中支架与传统的Conus术中支架在急性A型主动脉夹层(TAAAD)中的临床应用价值,并比较两种支架疗效的优劣。方法采用前瞻性随机对照研究方法,选取2016年7月-2017年10月在复旦大学附属中山医院心外科符合排除标准的32例TAAAD患者,15例术中应用Fontus支架(Fountus实验组),17例术中应用Conus支架(Conus对照组)。收集两组患者围术期及术后随访6个月的临床资料。结果两组患者术前一般临床资料比较差异无统计学意义(P〉0.05)。两组在术中情况包括主动脉根部及弓部的术式、附加手术等方面比较,差异均无统计学意义(P均〉0.05);在主动脉阻断时间、手术总时间等方面比较差异也无统计学意义(P均〉0.05)。在深低温停循环时间、左椎动脉缺血时间方面,Fountus实验组要明显优于Conus对照组[(26.7±9.1)min比(32.3±7.8)min,P=0.04;(26.7±9.1)min比(59.6±18.8)min,P〈0.01]。两组在围术期死亡率和术后肾功能衰竭、呼吸功能衰竭、感染、神经系统并发症以及机械通气时间、床旁血液透析、重症监护室时间和术后住院天数方面比较,差异均无统计学意义(P均〉0.05)。与Conus对照组相比,Fountus实验组在术后胸腔引流量[(769.5±429.1)ml比(935.6±368.2)ml]及输血量[(750.6±281.4)ml比(1015.4±428.9)ml]方面比较,差异有统计学意义(P〈0.01)。术后随访6个月,两组在主要心血管病事件、感染、再住院率等方面比较,差异无统计学意义(P均〉0.05);但Fontus实验组降主动脉假腔闭合率明显高于Conus对照组[(0.93±0.25)%比(0.76±0.17)%,P〈0.05]。Conus对照组出现1例支架内漏。结论Fontus支架在TAAAD术中的初步应用发现其具有较好的临床疗效,与传统Conus支架相比具有一定的优势,但还需多中心、大样本随机对照研究和长期随访进一步验证。 ObjectiveTo compare the clinical outcomes of two kinds of stents, i.e, Fontus or Conus frozen elephant trunk, in patients with type A acute aortic dissection (TAAAD) .MethodsThirty-two TAAAD patients were enrolled in this study. Among the patients, 15 patients received Fontus frozen elephant trunk (Fontus group) , when the other 17 cases were conservatively treated with Conus stent (Conus group) . Peri-operative and follow-up clinical data of all the patients were collected.ResultsThe preoperative clinical data of the two groups had no significant difference (P〉0.05) . The operative data, including surgical procedure, time of cardiopulmonary bypass, aorta cross-clamping, operation time, had no significant difference between the two groups (P〉0.05) . However, the Fontus group was significantly better than the Conus group in the time of deep hypothermia[ (26.7±9.1) min vs (32.3±7.8) min, P=0.04]and the ischemic time of the left vertebral artery[ (26.7±9.1) min vs (59.6±18.8) min, P〈0.01]. There was no significant difference in operative mortality and postoperative renal, respiratory failure, infection, neurological complications, mechanical ventilation time, bedside hemodialysis, intensive care unit time and postoperative hospitalization days between the two groups (P〉0.05) . However, compared with the Conus control group, there was a significant decrease in the blood loss and the volume of blood transfusion in the Fontus experimental group (P〈0.05) . After 6 months of follow-up, there was no significant difference between the two groups in the major cardiovascular events, infection, and rehospitalization rate (P〉0.05) . However, the false lumen thrombosis rate of the descending aorta in the Fontus group was significantly higher than that in the Conus group[ (0.93±0.25) % vs (0.76±0.17) %, P〈0.05]. Moreover, there was 1 case of stent leakage in the Conus control group.ConclusionThe initial application of Fontus stent in TAAAD has good clinical efficacy, which has certain advantages compared with Conus. However, a multicenter, large randomized controlled study is needed to verify the results.
作者 孙勇新 赖颢 张致琦 黄奔 陆树洋 李军 王毓琳 顾佳伟 王春生 Sun Yongxin;Lai Hao;Zhang Zhiqi;Huang Ben;Lu Shuyang;Li Jun;Wang Yulin;Gu Jiawei;Wang Chunsheng(Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University,Shanghai Institute of Cardiovascular Disease,Shanghai 200032,Chin)
出处 《中华血管外科杂志》 2018年第2期78-83,共6页 Chinese Journal of Vascular Surgery
基金 国家自然科学基金(81671942)
关键词 急性A型主动脉夹层 Fontus支架 Conus支架 Type A acute aortic dissection Fontus frozen elephant trunk Conus frozen elephant trunk
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