Comparison Of Castor Stent Graft And Chimney Stent Graft In The Treatment Of Aortic Arch Diseases With Insufficient Proximal Landing Zone

Objective:The data of patients with aortic arch diseases with insufficient proximal landing zone with LSA reconstruction were collected and summarized,and the short-term effects of Chimney stent graft and Castor stent graft were compared to provide some reference for follow-up clinical work.Methods:From November 2017 to March 2021,patients with aortic arch disease with LSA reconstruction treated by the Department of Cardiovascular surgery,Peking University Shenzhen Hospital were collected.Among them,27 cases received Castor single branch stent graft implantation and 35 cases received Chimney stent graft implantation,searching the hospitalization data of relevant patients,including basic data,past medical history,peri-operative data such as surgical process,postoperative to discharge,follow-up after discharge,etc.The collected data were analyzed by statistical methods,and the curative effects of chimney stent graft implantation and Castor branch stent graft implantation were evaluated.Result:All patients successfully completed Chimney stent graft implantation and Castor branch stent graft implantation.There was one death after operation in each of the two groups.But they all consider that it is related to the basic diseases of the patients themselves.In the Chimney group,35 cases met the criteria,8 cases lost follow-up,and finally 27 cases were enrolled in the group.In Castor group,27 cases met theVII criteria,3 cases lost follow-up,and 24 cases were finally enrolled in the group.There was no statistical difference in basic data between Chimney group and Castor group.There was no statistical difference in the diameter of proximal opening of LSA and the diameter of each section of aorta between the two groups before operation.The success rate of operation in both groups reached 100%,achieving the expected goal of operation.Compared with the operation time of the two groups,the operation time of the Castor group was longer.But there was no statistical difference in amount of bleeding and intraoperative complications between the two groups.In terms of perioperative complications,there were 2 cases of internal leakage in Chimney group and 1 case in Castor group.There was one postoperative death in both groups,but there was no statistical difference between the two groups.Follow-up:The follow-up data of two groups of patients within 1 year after discharge were collected.There was no statistical difference in complications between the two groups.1 year after discharge,follow-up CTA showed that: in the Chimney group,5 cases were partial thrombosis in false lumen and 21 cases were complete thrombosis in false lumen.In Castor group,4 cases were partial thrombosis in false lumen and 19 cases were complete thrombosis in false lumen.The difference was not statistically significant.Conclusions:1.Chimney stent graft and Castor stent graft are safe and reliable in the treatment of penetration aortic ulcer and Stanford B aortic dissection with inadequate length of proximal landing zone.The operation time of the "Chimney" technology is shorter than Castor stent graft.In clinic,the corresponding technology can be selected according to the specific situation.2.Comparing complications in perioperative and early follow-up,stent internal leakage,obstruction,stroke,LSA blood theft,spinal cord ischemia,left upper limb ischemia and death,there was no statistical difference between Chimney group and Castor group.However,the number of specimens is small,the source of specimens is simple,and the follow-up time is short,which needs to be verified by large specimens,multi-center and long-term follow-up studies.