Stent-graft versus open-surgical repair of the thoracic aorta: Mid-term results
Stent-graft versus open-surgical repair of the thoracic aorta: Mid-term results
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DOI：
10.1016/j.jvs.2006.08.005
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发表时间：
2006-12-01
影响因子：
4.3
通讯作者：
Cambria, Richard P.
中科院分区：
文献类型：
--
作者：
Stone, David H.;Brewster, David C.;Cambria, Richard P.
目的：支架植入术(SG)与开放胸主动脉修补术的关键和比较试验数据正在涌现。我们回顾了同期接受胸主动脉SG治疗的一系列患者的围手术期相关发病率、死亡率和中期结果。将这些数据与同期接受仅限于降主动脉的开放手术修复的患者队列进行比较。对1996年1月1日至2005年11月30日期间接受SG手术和开放胸主动脉手术的患者进行了回顾，这些患者来自前瞻性汇编的数据库。研究终点包括围手术期并发症、晚期存活率、免于再次干预和移植物相关并发症。多变量方法被用来评估可能与研究终点相关的变量；晚期结果与精算方法进行比较。105例患者中，平均年龄70岁，其中男性66例(62.9%)，退行性动脉瘤68例(64.7%)，穿透性溃疡12例(11.4%)，假性动脉瘤15例(14.3%)，外伤性撕裂9例(8.6%)，急性夹层1例(0.9%)。平均随访22个月(0~101个月)。89例(84.8%)SG患者在发病时无症状并接受选择性修复，而16例(15.2%)患者出现急性症状并接受紧急修复。围手术期死亡率为7.6%(8/105)，48个月生存率为54%+/-7%。因退行性病变接受治疗的SG患者围手术期死亡率为10.4%(8/77)。105名患者中有7名(6.7%)出现脊髓缺血并发症，其中2名患者出现一过性瘫痪，出院时症状消失。10.5%的患者(11/105)进行了再干预，48个月时不再干预的自由度接近81%。在同一时间间隔内，93例患者接受了胸降动脉瘤的开放手术修补(头部与腹腔轴吻合)。开放队列的围手术期死亡率为15.1%(14/93；P=0.09 vs SG修复)，48个月的精算生存率为%+/-6%。脊髓缺血并发症发生率为8.6%(8/93)，包括4例一过性瘫痪(P=0.44 vs SG修复术)。9例患者(9.7%)在随访期内需要再次手术干预，48个月不再干预的自由接近79%(P=0.73vs SG Repair)。手术死亡率与对照组相比降低了一半，两组的晚期存活率相似。切开修复组和SG组的再干预率几乎相同，两组患者的脊髓缺血并发症发生率相似。
Objective: Pivotal and comparative trial data are emerging for stent graft (SG) vs open repair of the thoracic aorta. We reviewed procedure-related perioperative morbidity, mortality, and mid-term outcomes in a contemporary series of patients treated with SG of the thoracic aorta. The data were compared with those of a patient cohort concurrently treated with open surgical repair confined to the descending aorta.Methods. A review of patients undergoing SG procedures and open surgery of the thoracic aorta from January 1, 1996, to November 30, 2005, was performed from a prospectively compiled database. Study end points included perioperative complications, late survival, freedom from reinterventions, and graft-related complications. Multivariate methods were used to assess variables potentially associated with study end points; late outcomes were compared with actuarial methods.Results. In 105 patients (mean age, 70 years; 66 male [62.9%]) SG repairs were done for 68 degenerative aneurysms (64.7%), 12 penetrating ulcers (11.4%), 15 pseudoaneurysms (14.3%), 9 traumatic tears (8.6%), and 1 acute dissection (0.9%). Mean follow-up was 22 months (range, 0 to 101 months). Eighty-nine (84.8%) SG patients were asymptomatic at presentation and underwent elective repair, whereas 16 (15.2%) presented with acute conditions and underwent urgent repair. Perioperative mortality was 7.6% (8/105), and actuarial survival at 48 months was 54% +/- 7%. The perioperative mortality rate among SG patients treated for degenerative pathology was 10.4% (8/77). Seven (6.7%) of 105 patients experienced spinal cord ischemic complications, including 2 patients with transient paraparesis that resolved by the time of discharge. Reinterventions were performed in 10.5% of patients (11/105), with freedom from reintervention approaching 81% by 48 months. Over the same interval, 93 patients were treated with open-surgical repair for descending thoracic aneurysm (anastomosis cephalad to the celiac axis). Perioperative mortality in the open cohort was 15.1% (14/93; P = .09 vs SG repair), and the 48-month actuarial survival was 64% +/- 6%. The incidence of spinal cord ischemic complications was 8.6% (8/93), including 4 patients with transient paraparesis (P = .44 vs SG repair). Nine patients (9.7%) required surgical reintervention during the follow-up period, with 48-month freedom from reintervention approaching 79% (P = .73 vs SG repair).Conclusions. Operative mortality was halved with SG, with similar late survival for both cohorts. Reinterventions were required at a nearly identical rate for open repair and SG, and both groups experienced similar rates of spinal cord ischemic complications.