Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results
Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results
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A型主动脉夹层的不同主动脉弓手术方法：临床结果和随访结果
DOI：
10.1093/icvts/ivaa095
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发表时间：
2020-08-01
影响因子：
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通讯作者：
Zhou, Qing
中科院分区：
文献类型：
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作者：
Xue, Yunxing;Pan, Jun;Zhou, Qing
目的：本研究的目的是探讨单中心A型主动脉夹层5种主要主动脉弓手术方法的临床结局和随访结果。方法：2002 - 2018年，将958例接受手术修复的A型主动脉夹层患者按弓手术方式分为5组：血弓置换术（206例）、岛状弓置换术（54例）、冷冻象鼻全弓置换术（425例）、三支支架置换术（39例）和开窗支架置换术（234例）。不同弓法的适应证与患者的术前状态、夹层的位置和程度以及术者的手术能力有关。我们进行了一项比较研究，以确定围手术期数据的差异，并使用Kaplan-Meier分析来评估长期生存率和再干预率。每组30名匹配的存活患者完成计算机断层血管造影以确定长期重塑效果。结果：30天死亡率为15.8%，5组间比较差异无统计学意义（P = 0.848）。5组患者随访生存率相近（P = 0.130），无再干预患者随访生存率相近（P = 0.471）。在倾向匹配研究中，植入支架（冷冻象鼻、三支支架、开窗支架）的患者主动脉扩张速度较慢，降主动脉和腹主动脉假腔血栓发生率高于未植入支架的患者。结论：弓部手术尚无标准方法，应结合临床资料确定适应证和远期疗效。根据我们的经验，简单的外科手术可以降低危重病人的死亡率，远端主动脉支架可以改善长期的重塑效果。
OBJECTIVES: The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre.METHODS: From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient's preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan-Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect.RESULTS: The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents.CONCLUSIONS: No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.