Proximalized total arch replacement can be safety performed by trainee （TraineeによるFrozen Elephant trunk法を用いた弓部大動脈置換術の安全性に関する検討）
著者
中西, 仙太郎
(Nakanishi, Sentaro)
上位タイトル
The Thoracic and cardiovascular surgeon
Vol.69,
No.4
(2021.
6)
,p.336-
344
識別番号
ISSN
0171-6425
DOI
10.1055/s-0040-1713354
その他
PMID:32634833
博士論文情報
学位授与番号
10107B487
学位授与年月日
2020-12-25
学位名
博士（医学）
学位授与機関
旭川医科大学
抄録
Background The aim of the present study was to validate safety of total arch replacement (TAR) using a novel frozen elephant trunk device, operated by trainees as surgical education.
Methods Sixty-four patients including 19 patients (29.6%) with acute aortic dissection type A (AADA) underwent TAR in our institute between April 2014 and March 2019 were retrospectively analyzed. Twenty-nine patients were operated by trainees (group T) and 35 patients were operated by attending surgeons (group A).
Results Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes, p = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes, p = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes, p = 0.001) were significantly shorter in group A than in group T, but aortic clamping time did not differ between groups (115.3 ± 55.7 vs. 114.2 ± 35.0 minutes, p = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%, p = 0.014). Thirty-day mortality was 3.1% in the entire cohort. Although operation time was longer in group T, there were no significant difference in postoperative results between the groups, and the experience levels of the main operator were not independent predictors for in-hospital mortality + major postoperative complications. There was no difference in late death and aortic events between groups.
Conclusions The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.
