马凡综合征并发A型主动脉夹层患者“象鼻”支架植入术后降主动脉重建分析

Analysis of descending aorta remodeling after frozen elephant-trunk stent implantation in patients with type A aortic dissection combined with Marfan syndrome

目的通过影像学随访分析马凡综合征并发A型主动脉夹层患者行“象鼻”支架置入术后的降主动脉重建变化的规律。方法共纳入2015年1月到2019年8月广东省心血管病研究所诊断为马凡综合征并发A型主动脉夹层且行全弓置换联合“象鼻”支架置入的患者27例,年龄(29.56±7.87)岁,分为急性组(19例)及亚急性/慢性组(8例)。记录患者的一般临床资料、术中资料,于术前、术后1个月、术后3个月、术后1年及之后的每年进行主动脉计算机断层扫描血管造影(computed tomography angiography,CTA)评价。结果所有手术患者均顺利出院,随访率100%,术后随访时间为(24.5±16.0)个月。急性组患者支架置入术后降主动脉支架覆盖区呈现出真腔扩大(P<0.001),假腔缩小(P=0.016),主动脉直径保持稳定(P>0.05),在之后的随访中,主动脉直径、真腔与假腔保持稳定;在降主动脉无支架覆盖区,术后真假腔及总直径与术前比较,差异无统计学意义(P>0.05),但术后的随访过程中,各平面主动脉直径及真腔均有增大(P<0.05),假腔保持稳定。亚急性/慢性组患者支架置入术后降主动脉支架覆盖区出现真腔扩大(P=0.048),主动脉直径与假腔保持稳定,之后的随访中主动脉直径与真假腔直径均保持稳定;在降主动脉无支架覆盖区,各层面主动脉直径、真假腔直径术前、术后比较,差异无统计学意义(P>0.05),并且在术后随访中,也保持稳定。术后主动脉假腔完全血栓化在急性组与亚急性/慢性组胸段可达到72.2%和75%,而在腹主动脉层面仅有10.5%和62.5%。结论全弓置换联合降主动脉支架置入术治疗马凡综合征并发A型主动脉夹层患者,有利于促进支架段血栓化形成,促进胸段重建稳定,维持术后近中期各层面主动脉直径及真、假腔直径的稳定。

Objectives To analyze the changes of descending aorta remodeling in patients with Marfan syndrome(MFS)combined with type A aortic dissection after frozen elephant-trunk(FET)stent implantation.Methods Between January 2015 and August 2019,27 patients[aged(29.56±7.87)years]with MFS complicated with type A aortic dissection who underwent total arch replacement and FET stent implantation were included in this study.They were divided into acute group(n=19)and subacute/chronic group(n=8).General clinical data,clinical data during operation of the patients were recorded and computed tomography angiography(CTA)was performed on them before operation,1 month,3 months,1 year after operation and then every year.Results All the patients discharged smoothly.The follow-up rate was 100%and follow-up duration was(24.5±16.0)months.In acute group,the descending aortic with stent after operation showed the true lumen expanded(P<0.001),the false lumen shrank(P=0.016),and the total diameter of the aorta remained stable(P>0.05).During follow-up,the descending aortic with stent showed the true lumen,the false lumen and the total aortic remained stable.In the descending aorta without stent,there was no significant difference in true and false lumen and total diameter before and after surgery(P>0.05),but the diameter of true lumen and the total aorta increased(P<0.05).In subacute/chronic group,the descending aortic with stent after operation showed the true lumen expanded(P=0.048),the false lumen and the total aorta remained stable(P>0.05).During follow-up,the true lumen,the false lumen and total aortic of all descending aortic remained stable(P>0.05).Postoperative complete thrombosis of the level of thoracic descending aortic was 72.2%and 75%,but only 10.5%and 62.5%in the abdominal aortic level.Conclusions Total arch replacement and FET stent implantation in the treatment of MFS combined with type A aortic dissection is conductive to promote the formation of stent segment thrombosis,promote the remodeling stability of thoracic segment,and maintain the stability of total aortic,true lumen and false lumen diameter at all levels in the short and middle follow-up.