非解剖性科默雷尔动脉瘤破裂的紧急混合手术方法：病例报告系列,Journal of Cardiothoracic Surgery

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非解剖性科默雷尔动脉瘤破裂的紧急混合手术方法：病例报告系列
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-03-24 , DOI: 10.1186/s13019-023-02156-x
Alejandro Velandia-Sánchez _{1,

2} , Sebastián Gómez-Galán _{1,

2} , Sebastian Gallo-Bernal _{1,

3} , Camilo A Polania-Sandoval _{1,

2} , Ivonne G Pineda-Rodríguez _{1,

4} , Paula Florez-Amaya _{1,

2} , Lina M Sanabria-Arévalo _{1,

2} , Julián Senosiain-González ₂ , Juan G Barrera-Carvajal _{1,

2,

4} , Juan P Umana _{2,

4} , Jaime Camacho-Mackenzie _{1,

2,

4}

Affiliation

科默雷尔动脉瘤是一种囊状或梭形扩张，见于 3-8% 的科默雷尔憩室病例。据报道，非解剖性破裂率为 6%。如果破裂，通常会进行紧急手术矫正。然而，关于这种急性情况下最佳手术方法的证据很少。在本病例报告系列中，我们旨在描述我们采用混合紧急手术方法治疗 1 型非解剖性破裂 Kommerell 动脉瘤的经验。从2005年1月到2020年12月，发现了3例需要紧急手术修复的1型非解剖性破裂Kommerell动脉瘤。平均年龄为 66.67 ± 7.76 岁，其中 3/3 为男性。最常见的症状是非典型胸痛、呼吸困难和头痛 (2/3)。动脉瘤的平均直径为 63.67 ± 5.69 mm。冷冻象鼻是首选手术方法 (2/3)。非冷冻象鼻患者接受了混合手术，包括主动脉上脱支和 2 区覆膜支架部署。我们发现平均钳夹时间为 140 ± 60.75 分钟，心脏骤停时间为 51.33 ± 3.06 分钟，住院时间为 13.67 ± 5.51 天。最常见的并发症是手术部位感染和休克（2/3）。仅 1 名患者死亡（1/3）。非解剖性科默雷尔动脉瘤破裂的治疗证据很少。需要进行额外的、稳健的、更广泛的研究。选择合适的手术方法具有挑战性，每个患者都应该个体化。冷冻象鼻对于我们中心需要紧急手术修复的患者来说是可行的。然而，也可以执行其他混合或开放程序。

"点击查看英文标题和摘要"

Emergent hybrid surgical approaches for non-dissecting ruptured Kommerell's aneurysm: a case report series

Kommerell’s aneurysm is a saccular or fusiform dilatation found in 3–8% of Kommerell’s diverticulum cases. A non-dissecting rupture rate of 6% has been reported. If ruptured, emergent surgical correction is usually granted. However, evidence regarding the optimal surgical approach in this acute setting is scarce. In this case report series, we aim to describe our experience managing type-1 non-dissecting ruptured Kommerell's aneurysm with hybrid emergent surgical approaches. From January 2005 to December 2020, three cases of type-1 non-dissecting ruptured Kommerell's aneurysm requiring emergent surgical repair were identified. The mean age was 66.67 ± 7.76 years, and 3/3 were male. The most common symptoms were atypical chest pain, dyspnoea, and headache (2/3). The mean aneurysm’s diameter was 63.67 ± 5.69 mm. Frozen Elephant Trunk was the preferred surgical approach (2/3). The Non-Frozen Elephant Trunk patient underwent a hybrid procedure consisting of a supra-aortic debranching and a zone-2 stent-graft deployment. We found a mean clamp time of 140 ± 60.75 min, cardiac arrest time of 51.33 ± 3.06 min, and a hospital stay of 13.67 ± 5.51 days. The most common complications were surgical-site infection and shock (2/3). Only one patient died (1/3). Evidence of management for non-dissecting ruptured Kommerell's aneurysms is scarce. Additional, robust, and more extensive studies are required. The selection of the appropriate surgical approach is challenging, and each patient should be individualized. Frozen Elephant Trunk was feasible for patients requiring emergent surgical repair in our centre. However, other hybrid or open procedures can be performed.

更新日期：2023-03-24

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