近位化したアーチ全置換術は研修医が安全に行える

Proximalized Total Arch Replacement Can Be Safely Performed by Trainee.

• Sentaro Nakanishi
• Naohiro Wakabayashi
• Hayato Ise
• Hiroto Kitahara
• Aina Hirofuji
• Natsuya Ishikawa
• Hiroyuki Kamiya

抄録

背景:

"Zs_2003"本研究の目的は、外科教育として研修医が操作する新しい冷凍象体幹装置を用いたアーチ全置換術(TAR)の安全性を検証することであった。

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.

方法:

"Zs_2003"2014年4月から2019年3月までの間に当院でTARを受けた急性大動脈解離型（AADA）19例（29.6%）を含む44例をレトロスペクティブに解析した。29人の患者は研修医（T群）、35人の患者はアテンド外科医（A群）が手術を行った。

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).

結果:

"Zs_2003"患者の特徴は群間で差がなかった。手術時間（409.4±87.8分 vs. 468.6±129.6分、=0.034）、心肺バイパス時間（177.7±50.4分 vs. 222.9±596.7 分、＝0.019）、低体温循環停止時間（39.5±13.4 vs. 54.5±18.5 分、＝0.001）は、A群で有意に短かった。001）はA群の方がT群よりも有意に短かったが、大動脈クランプ時間はA群の方が手術の併発率が高かったため、群間差はなかった（115.3±55.7 vs. 114.2±35.0分、＝0.924）。30日死亡率はコホート全体で3.1％であった。手術時間はT群の方が長かったが、術後の成績には群間で有意差はなく、主術者の経験レベルは院内死亡＋主要な術後合併症の独立した予測因子ではなかった。晩期死亡と大動脈イベントには群間で差はなかった。

RESULTS:  Patient characteristics did not differ between groups. Operative time (409.4 ± 87.8 vs. 468.6 ± 129.6 minutes,  = 0.034), cardiopulmonary bypass time (177.7 ± 50.4 vs. 222.9 ± 596.7 minutes,  = 0.019), and hypothermic circulatory arrest time (39.5 ± 13.4 vs. 54.5 ± 18.5 minutes,  = 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,  = 0.924) because the rate of concomitant surgery was higher in group A (37.1 vs. 10.3%,  = 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.

結論:

"Zs_2003"本研究では、TARが訓練生に安全に実施できることを実証し、TARが可能で安全な教育的操作であることを示唆した。

CONCLUSIONS:  The present study demonstrated that TAR can be safely performed by trainees, and suggests TAR as a possible and safe educational operation.

Georg Thieme Verlag KG Stuttgart · New York.