Outcomes after concomitant arch replacement at the time of aortic root surgery.
Outcomes after concomitant arch replacement at the time of aortic root surgery.
复制标题
主动脉根部手术同时进行弓形置换后的结果。
DOI：
10.1016/j.xjon.2022.12.014
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
MacArthur,JohnWard
中科院分区：
文献类型：
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作者：
Krishnan,Aravind;Dalal,AlexR;Pedroza,AlbertJames;Nakamura,Ken;Yokoyama,Nobu;Tognozzi,Emily;Woo,YJoseph;Fischbein,Michael;MacArthur,JohnWard
背景目前在主动脉根部手术时行主动脉弓置换术的患者数量有限，且多为半主动脉弓置换。我们描述了主动脉根和伴随的主动脉弓置换术后的结果，包括全弓replacement.MethodsThis单机构回顾性分析研究了1196例连续患者从2004年5月至2020年9月谁接受了首次主动脉根置换术。排除了因心内膜炎接受手术的患者（n = 68，5.7%）。根据适应症、临床和手术特征、人口统计学、病史（包括结缔组织疾病）和紧迫性，将接受同期牙根和牙弓置换的患者与接受单独牙根手术的患者进行倾向匹配。多变量考克斯比例风险和逻辑回归模型用于评估全因死亡率的主要结局和延长呼吸机使用、术后输血和衰弱性卒中的次要结局，并根据患者和手术特征进行调整。471例（41.8%）同时行主动脉弓置换术。大多数患者接受半弓置换（n = 411，87.4%）; 59例患者（12.6%）接受全弓置换（有象鼻：n = 23，4.9%;无象鼻：n = 36，7.7%）。平均随访时间为术后4.6年。手术死亡率为2.2%，整个研究期间的总死亡率为9.2%。倾向匹配产生348个匹配（295个伴随半弓，53个伴随全弓）。同时行半弓（危险比，1.00; 95%可信区间，0.54- 1.86，P = 0.99）和全弓置换（危险比，1.60，95%可信区间，0.72- 3.57，P = 0.24）与死亡率增加无显著相关性。各组的卒中发生率无显著差异：单独牙根（n = 11/348，3.7%）、牙根+半弓（n = 17/295，5.8%）和牙根+全弓（n = 3/53，5.7%）置换（P= 0.50），卒中的校正风险也无显著差异。这两个伴随弓干预与长期使用呼吸机和使用术后bloodtransfusions.ConclusionsHemiarch和全弓置换术是安全的，在主动脉根干预的时间进行，没有显着差异的生存率或中风率，但增加呼吸机和血液制品的使用。
BackgroundContemporary series of aortic arch replacement at the time of aortic root surgery are limited in number of patients and mostly address hemiarch replacement. We describe outcomes after aortic root and concomitant arch replacement, including total arch replacement.MethodsThis single-institution retrospective review studied 1196 consecutive patients from May 2004 to September 2020 who underwent first-time aortic root replacement. Patients undergoing surgery for endocarditis were excluded (n = 68, 5.7%). Patients undergoing concomitant root and arch replacement were propensity matched with patients undergoing isolated root surgery based on indication, clinical and operative characteristics, demographics, medical history including connective tissue disorders, and urgency. Multivariable Cox proportional hazards and logistic regression modeling were used to assess the primary outcome of all-cause mortality and the secondary outcomes of prolonged ventilator use, postoperative blood transfusion, and debilitating stroke, adjusted for patient and operative characteristics.ResultsAmong the 1128 patients who underwent aortic root intervention during the study period, 471 (41.8%) underwent concomitant aortic arch replacement. Most underwent hemiarch replacement (n = 411, 87.4%); 59 patients (12.6%) underwent total arch replacement (with elephant trunk: n = 23, 4.9%; without elephant trunk: n = 36, 7.7%). The mean follow-up time was 4.6 years postprocedure. Operative mortality was 2.2%, and total mortality over the entire study period was 9.2%. Propensity matching generated 348 matches (295 concomitant hemiarch, 53 concomitant total arch). Concomitant hemiarch (hazard ratio, 1.00; 95% confidence interval, 0.54-1.86,P= .99) and total arch replacement (hazard ratio, 1.60, 95% confidence interval, 0.72-3.57,P= .24) were not significantly associated with increased mortality. Rates of stroke were not significantly different among each group: isolated root (n = 11/348, 3.7%), root + hemiarch (n = 17/295, 5.8%), and root + total arch (n = 3/53, 5.7%) replacement (P= .50), nor was the adjusted risk of stroke. Both concomitant arch interventions were associated with prolonged ventilator use and use of postoperative blood transfusions.ConclusionsHemiarch and total arch replacement are safe to perform at the time of aortic root intervention, with no significant differences in survival or stroke rates, but increased ventilator and blood product use.