Determinants of early and late outcome for reoperations of the proximal aorta
Determinants of early and late outcome for reoperations of the proximal aorta
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DOI：
10.1016/j.athoracsur.2004.03.085
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发表时间：
2004-09-01
影响因子：
4.6
通讯作者：
Safi, HJ
中科院分区：
文献类型：
--
作者：
Estrera, AL;Miller, CC;Safi, HJ
背景。本研究的目的是调查升主动脉和主动脉弓再次手术的原因，并确定早期和晚期结果的决定因素。方法。 1991 年 1 月至 2003 年 3 月期间，我们修复了 597 名患者的近端主动脉瘤。在这些患者中，104 例接受了升主动脉、主动脉根部或主动脉横弓置换术的再次手术。既往手术被定义为任何先前的心脏或近端主动脉修复手术。中位年龄为 60 岁，其中 29 名患者 (28%) 为女性。再次手术和置换近端主动脉的指征包括急性A型夹层6例（5.8%）、动脉瘤伴慢性夹层60例（57.7%）、动脉瘤进展23例（22.1%）、感染12例（1.5%）。炎症性疾病 2 例（1.9%），动脉粥样硬化性疾病 1 例（1.0%）。再次手术包括主动脉根部置换术 20 例（19.2%）、象鼻全弓置换术 28 例（26.7%）、升主动脉弓和近弓置换术 39 例（37.5%）、升主动脉 27 例（26.0%）。手术之间的中位间隔为 69 个月。 80例（77%）采用逆行脑灌注。结果。慢性夹层是我们人群中最常见的再手术指标，其次是动脉瘤进展和感染。 30 天死亡率和院内死亡率分别为 13.5%（104 人中的 14 人）和 15.4%（104 人中的 16 人）。慢性阻塞性肺疾病、肾功能障碍和泵时间延长是死亡的危险因素。中位随访时间为 5.02 年。八名患者在此期间死亡。 1 年、5 年和 10 年的估计生存率分别为 83%、80% 和 62%。免于第二次近端再次手术的率为 97.1%（104 例中有 10 例）。无需进行后续远端胸主动脉修复的率为 84.6%（104 例中的 8 例）。结论。升主动脉和主动脉弓的再次手术可以安全地进行，并具有良好的长期效果。既往接受过近端主动脉夹层修复术的患者需要长期监测。在近端主动脉再次手术之前必须仔细考虑肾功能障碍和慢性阻塞性肺疾病。 (C) 2004 年，胸外科医师协会。
Background. The purpose of this study was to investigate the cause of ascending aorta and aortic arch reoperations and to identify determinants of early and late outcome.Methods. Between January 1991 and March 2003 we repaired aneurysms of the proximal aorta in 597 patients. Of these patients, 104 had reoperations for replacement of the ascending aorta, aortic root, or transverse aortic arch. Previous surgery was defined as any previous cardiac or proximal aortic repair. Median age was 60 years, and 29 of the patients (28%) were female. Indications for reoperation and replacement of the proximal aorta included acute type A dissection in 6 patients (5.8%), aneurysm with chronic dissection in 60 (57.7%), progression of aneurysm in 23 (22.1%), infection in 12 (1.5%). inflammatory disease in 2 (1.9%), and atheromatous disease in 1 (1.0%). Reoperations included aortic root replacement in 20 patients (19.2%), total arch replacement with elephant trunk in 28 (26.7%), ascending and proximal arch in 39 (37.5%), and ascending aorta in 27 (26.0%). The median interval between operations was 69 months. Retrograde cerebral perfusion was used in 80 (77%) cases.Results. Chronic dissection was the most common indicator for reoperation in our population, followed by progression of aneurysm and infection. Thirty-day and in-hospital mortality was 13.5% (14 of 104) and 15.4% (16 of 104), respectively. Chronic obstructive pulmonary disease, renal dysfunction, and increased pump time were risk factors for mortality. Median follow-up was 5.02 years. Eight patients died during that period. Estimated survival at 1, 5, and 10 years was 83%, 80%, and 62%, respectively. Freedom from second proximal reoperations was 97.1% (10 of 104). Freedom from subsequent distal thoracic aortic repair was 84.6% (8 of 104).Conclusions. Reoperations of the ascending aorta and aortic arch can be performed safely with good long-term results. Patients with previous proximal aortic dissection repair need long-term surveillance. Renal dysfunction and chronic obstructive pulmonary disease must be carefully considered before reoperations of the proximal aorta. (C) 2004 by The Society of Thoracic Surgeons.