腔内修复术在升主动脉及主动脉根部疾病中的应用

The current status and prospect of catheter-based treatment of ascending aorta and aortic root diseases

近年来,心血管外科领域经导管腔内治疗的理念、技术、材料发展迅速,适应证不断扩展,深刻影响着心血管外科技术的发展方向。主动脉腔内修复术已成为急、慢性远端主动脉弓或胸部降主动脉、腹主动脉病变的常规治疗方法,在升主动脉疾病包括升主动脉瘤、假性动脉瘤及急慢性夹层、壁间血肿、穿透性溃疡等的治疗中亦受到关注并有相应报道。相比于经典外科开放手术,腔内修复术具有微创优势,增加了高危患者的治疗选择。由于升主动脉和主动脉根部解剖结构特殊,支架材料和手术器械选择有限,腔内修复术还存在很多亟待解决的问题。该术式的中长期疗效亦缺乏可靠的临床证据,其安全性和有效性尚需进一步研究。

In recent years,the endovascular procedures has considerably evolved in concepts,technologies,materials and devices on cardiovascular surgery,and influenced the development and the future direction of cardiovascular surgery technology.Endovascular aorta repair is well recognized as the optimal therapy for patients presenting with acute or chronic pathology of distal aortic arch,descending aorta and thoraco-abdominal aorta.The use of catheter-based endovascular repair in the ascending aorta pathology including aneurysms,pseudoaneurysms,penetrating aortic ulcers and acute or chronic Stanford type A aortic dissection has been concerned and reported.Comparing to the open surgical procedures for ascending aorta and aortic root disease with high perioperative mortality and morbidity,the catheter-based endovascular repair has minimally invasive,expanding the alternative treatment of ascending aorta disease,especially for patients with high-risk profiles.However,due to the complex anatomy and functional properties,materials and devices,the use of this technique in ascending aorta and aortic root is still questionable.In addition,the long-term and reliable clinical research results is still inadequate,and the safety and effectiveness need further research.