In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke
In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke
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DOI：
10.1016/j.athoracsur.2017.05.026
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发表时间：
2017-12-01
影响因子：
4.6
通讯作者：
Elefteriades, John A.
中科院分区：
文献类型：
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作者：
Dumfarth, Julia;Peterss, Sven;Elefteriades, John A.
背景。该研究旨在评估牛主动脉弓 (BAA) 是否影响急性 A 型主动脉夹层 (AADA) 的入口位置，并确定 BAA 对术后结果（尤其是中风）的影响。方法。 2002 年至 2015 年间，共有 315 名 AADA DeBakey I 型患者（72.1% 为男性，平均年龄 59.5 +/- 13.4 岁）接受了手术。影像学研究和手术报告针对 BAA 的存在和进入部位的位置进行了筛查。根据 BAA 存在 (BAA+) 和不存在 (BAA-) 将患者分为 2 组（BAA+ n = 49，BAA-n = 264）。分析了解剖模式、手术治疗、术后并发症的危险因素和长期结果。结果。 AADA 患者中 BAA 的患病率为 15.6%。 BAA 患者的入口部位更常见于主动脉弓（BAA+ 46.8% 对比 BAA-14.3%；p < 0.001）。多变量分析确定 BAA（比值比 [OR]，5.9；95% 置信区间 [CI]，2.89 至 12.04；p < 0.001）和术前主动脉瓣正常（OR，2.26；95% CI，1.19 至 4.31；p = 0.013）作为弓形撕裂的独立预测因子。 39 名患者（12.4%）患有中风。 BAA 患者的卒中发生率较高（BAA+ 24.5% 对比 BAA-10.2%；p = 0.009）。 BAA 成为 AADA 中卒中的危险因素之一（OR，2.69；95% CI，1.2 至 6.0；p = 0.016）。 BAA 患者和无先天性牙弓异常的患者的长期生存率相当。结论。 BAA 是主动脉弓入口部位的独特位置和中风危险因素的独立预测因子。 (C) 2017 年胸外科医师协会
Background. The study sought to evaluate if a bovine aortic arch (BAA) influences the location of the entry site in acute aortic dissection type A (AADA) and to identify the impact of BAA on postoperative outcome, especially stroke.Methods. A total of 315 patients underwent surgery due to AADA DeBakey type I (72.1% men, mean age 59.5 +/- 13.4 years) between 2002 and 2015. Imaging studies and operative reports were screened for presence of BAA and location of the entry site. Patients were divided into 2 groups based on presence (BAA+) and absence (BAA-) of BAA (BAA+ n = 49, BAA-n = 264). Dissection patterns, surgical treatment, risk factors for postoperative complications, and long-term outcome were analyzed.Results. Prevalence of BAA in patients with AADA was 15.6%. Location of the entry site was more commonly in the aortic arch in patients with BAA (BAA+ 46.8% versus BAA-14.3%; p < 0.001). Multivariable analysis identified BAA (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.89 to 12.04; p < 0.001) and preoperative competent aortic valve (OR, 2.26; 95% CI, 1.19 to 4.31; p = 0.013) as independent predictors for an arch tear. Thirty-nine patients (12.4%) suffered from stroke. Patients with BAA had higher stroke rates (BAA+ 24.5% versus BAA-10.2%; p = 0.009). BAA emerged as one risk factor for stroke in the setting of AADA (OR, 2.69; 95% CI, 1.2 to 6.0; p = 0.016). Long-term survival was comparable for patients with BAA and patients without congenital arch anomalies.Conclusions. BAA is an independent predictor for the distinctive location of the entry site in the aortic arch and risk factor for stroke. (C) 2017 by The Society of Thoracic Surgeons