Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery?
Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery?
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DOI：
10.1016/j.athoracsur.2010.03.092
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发表时间：
2010-08-01
影响因子：
4.6
通讯作者：
Rodriguez, Jose E.
中科院分区：
文献类型：
--
作者：
Silva, Jacobo;Maroto, Luis C.;Rodriguez, Jose E.
背景。本研究的目的是分析主动脉根和（或）升主动脉再次手术后的中期手术和生存资料，并将这些结果与首次手术后的结果进行比较。在6年的时间里，365例患者在我们中心接受了主动脉根部和（或）升主动脉手术。患者平均年龄为63.1±25.5岁；27.1%是女性。58例患者先前接受过升主动脉和（或）主动脉瓣手术（I组），其余307例患者被分配到初始手术组（II组）。再手术方式为本特尔手术45例（77.6%），升主动脉及瓣膜置换术8例（13.8%），升主动脉置换术5例（8.6%）。再手术组的术前风险状况更差，欧洲心脏手术风险评估系统的logistic评分更高：I组（26.9）比II组（9.9）（p < 0.0001）。I组住院死亡率为58人中7人（12.1%），II组为207人中21人（6.8%）（p = 0.18；相对危险度为1.9[0.8 ~ 4.6]）。在调整了不同的变量后，再手术不能被确定为术后发病率的独立预测因子。第一组1年生存率（包括住院死亡率）较低（77.9 +/- 1.11% vs 91.9 +/- 0.3%）， 3年生存率较低（75.3 +/- 0.11% vs 88.9 +/- 0.03% [log-rank p = 0.005]）。在多因素分析中，一旦校正了随访期间预测死亡率的变量，再手术（p = 0.01；风险比2.6[1.2至5.3]）是生存率的决定性因素。对升主动脉和主动脉根的再手术显示出可接受的发病率和死亡率。他们的中期生存率低于不需要重复手术的患者。
Background. The aim of this study was to analyze surgery and survival data in the midterm after aortic root and (or) ascending aorta reoperations and compare these results with those obtained after first time surgery.Methods. Over a 6-year period, 365 patients underwent an aortic root and (or) ascending aorta surgery procedure at our center. Mean patient age was 63.1 +/- 25.5 years; 27.1% were women. Fifty-eight patients had had prior ascending aorta and (or) aortic valve surgery (group I) and the remaining 307 patients were assigned to an initial surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), ascending aorta and valve replacement in 8 (13.8%), and ascending aorta replacement in 5 (8.6%).Results. The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) (p < 0.0001). Hospital mortality was 7 of 58 (12.1%) in group I and 21 of 207 (6.8%) in group II (p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 +/- 1.11% vs 91.9 +/- 0.3%) and at 3 years (75.3 +/- 0.11% vs 88.9 +/- 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation (p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up.Conclusions. Reoperations on the ascending aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.