Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients.
Comparison of Prognosis Between Hybrid Debranching Surgery and Total Open Arch Replacement With Frozen Elephant Trunk for Type A Acute Aortic Syndrome Patients.
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混合断支手术与冷冻象鼻全开弓置换术治疗 A 型急性主动脉综合征患者的预后比较
DOI：
10.3389/fcvm.2021.689507
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发表时间：
2021
影响因子：
3.6
通讯作者：
Gong M
中科院分区：
文献类型：
--
作者：
Li J;Li L;Wang M;Li H;Sun L;Liu Y;Fan R;Zhang Z;Zou C;Zhang H;Gong M
背景资料：目前尚不清楚全弓置换术（TAR）联合冷冻象鼻（FET）植入术和混合去支手术对A型急性主动脉综合征（AAS）患者的预后是否有差异。我们试图比较全弓置换术（TAR）联合冷冻象鼻（FET）植入术和混合去支手术治疗A型急性主动脉综合征（AAS）患者的短期和长期预后。研究方法：从2014年1月至2020年9月，共纳入了518例接受TAR联合FET手术的患者和31例接受混合手术的患者。我们分析了两种手术方法的术后死亡率和并发症发生率，并通过1：2的倾向评分匹配（PSM）确定了67例患者进行亚组分析。我们通过多元回归分析确定了患者死亡率和术后神经系统并发症的危险因素。结果如下：与TAR + FET组相比，混合手术可缩短主动脉阻断时间，减少术中失血量，避免部分患者体外循环。TAR + FET组和混合手术组之间的30天死亡率无显著差异（10.6% vs. 9.7%）。然而，混合手术增加了患者永久性神经系统并发症的发生率（95%CI：4.7- 35.7%，P = 0.001），尤其是术后脑梗死（P < 0.001）。在平均31.6个月的随访期内，TAR联合FET组与杂交手术组的1年生存率和3年生存率无显著差异（P = 0.811），但杂交手术增加了远期神经系统并发症的发生率（P < 0.001）。多因素回归分析显示，手术方式不是术后死亡的危险因素，而混合手术是术后神经系统并发症的危险因素（P < 0.001）。结论：杂交手术是治疗AAS的一种可接受的治疗方法，其术后死亡率与FET相似。但混合手术可能会增加术后永久性神经系统并发症的风险，在选择混合手术时必须仔细考虑这种风险。
Background: It is unclear whether the total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery have a difference in the prognosis of patients with type A acute aortic syndrome (AAS). We attempted to compare the short-term and long-term prognosis of total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation and hybrid debranching surgery in patients with type A acute aortic syndrome (AAS). Methods: From January 2014 to September 2020, a total of 518 patients who underwent TAR with FET surgery and 31 patients who underwent hybrid surgery were included. We analyzed the post-operative mortality and morbidity of complications of the two surgical methods, and we determined 67 patients for subgroup analysis through a 1:2 propensity score match (PSM). We identified risk factors for patient mortality and post-operative neurological complications through multivariate regression analysis. Results: Compared with the TAR with FET group, hybrid surgery could reduce aortic cross-clamp time, reduce intraoperative blood loss and prevent some patients from cardiopulmonary bypass. There was no significant difference in 30-day mortality between the TAR with FET group and the hybrid surgery group (10.6 vs. 9.7%). However, hybrid surgery had increased the incidence of permanent neurological complications in patients (95%CI: 4.7–35.7%, P = 0.001), especially post-operative cerebral infarction (P < 0.001). During the average follow-up period of 31.6 months, there was no significant difference in the 1-year survival rate and 3-year survival rate between the TAR with FET group and the hybrid surgery group (P = 0.811), but hybrid surgery increased the incidence of long-term neurological complications (P < 0.001). In multivariate regression analysis, surgical methods were not a risk factor for post-operative deaths, but hybrid surgery was a risk factor for post-operative neurological complications (P < 0.001). Conclusions: Hybrid surgery is an acceptable treatment for AAS, and its post-operative mortality is similar to FET. But hybrid surgery may increase the risk of permanent neurological complications after surgery, and this risk must be carefully considered when choosing hybrid surgery.
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影响因子：
4.3
作者：
Fillinger, Mark F.;Greenberg, Roy K.;Chaikof, Elliot L.
通讯作者：
Chaikof, Elliot L.
影响因子：
39.3
作者：
Erbel, Raimund;Aboyans, Victor;Vrints, Christiaan J. M.
通讯作者：
Vrints, Christiaan J. M.
影响因子：
37.8
作者：
Sun, LiZhong;Qi, RuiDong;Zheng, Jun
通讯作者：
Zheng, Jun
影响因子：
1.5
作者：
He, Xingwei;Liu, Wanjun;Zeng, Hesong
通讯作者：
Zeng, Hesong
影响因子：
3.4
作者：
Czerny, Martin;Schmidli, Jurg;Wyss, Thomas R.
通讯作者：
Wyss, Thomas R.