摘要目的:评价升主动脉置换术后弓部病变的微创治疗效果。方法:回顾性分析2016年至2024年四川大学华西医院心脏大血管外科升主动脉置换术后弓部病变患者临床资料。经过多学科评估高危风险不适合传统开放手术，采用不同微创主动脉腔内修复方式，包括Ⅳb型杂交，医师改良支架及一体化创新支架。研究终点为技术成功率、住院和随访期间的死亡、卒中、内漏和弓上分支通畅情况。结果:共纳入40例患者，男32例，女8例，中位年龄60岁。手术成功率100%，无死亡及卒中，弓上分支通畅率100%。10例行Ⅳb型杂交手术，无卒中及内漏发生。22例采用医师改良支架，2例发生内漏，1例因Ⅰc型内漏持续存在再次干预，1例因入路血管损伤行股动脉置换。8例采用一体化创新支架，1例因Ⅰc型内漏持续存在进行再次手术干预。结论:随着腔内修复技术及器械的发展运用，再次开放手术风险较高的主动脉弓病变患者，采用不同微创治疗方法可获得良好的结局，但远期临床结局仍需要长期随访及大样本的研究。

abstractsObjective:To evaluate the outcomes of minimally invasive therapy for aortic arch pathology after ascending aortic replacement.Methods:A retrospective analysis was conducted at the Department of Cardiovascular Surgery, West China Hospital of Sichuan University from 2016 to 2024. After multidisciplinary discussion, these included patients were evaluated to be at high risk for traditional open surgery. Various minimally invasive repair techniques were employed, including Ⅳb hybrid technique, physician-modified endograft and novel unibody endograft. The study outcomes were technical success, in-hospital and follow-up mortality, stroke, endoleak, and the patency of the supra-aortic vessels.Results:A total of 40 patients(32 males and 8 females) with a median age of 60 years old were included in this study. The technique success rate was 100%, with no deaths or strokes reported. The patency of the supra-aortic vessels was 100%. 10 patients underwent Type Ⅳb hybrid surgery without any endoleaks occurring. Among the 22 patients who received physician-modified endograft, endoleaks were observed in 2 cases. One of these type Ⅰc endoleaks persisted and underwent reintervention. One patient underwent femoral artery replacement due to vascular injury. For the 8 patients who received novel unibody endograft, one case required reintervention due to persistent type Ⅰc endoleaks.Conclusion:With the development of different endovascular techniques and novel branched endograft, patients with aortic arch pathology who are at high risk for redo open surgery can achieve favorable outcomes with various minimal invasive techniques. However, long-term and large-sample follow-up studies are needed for further evaluation.