Imaging Surveillance After Proximal Aortic Operations: Is it Necessary?
Imaging Surveillance After Proximal Aortic Operations: Is it Necessary?
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近端主动脉手术后的影像学监测：有必要吗？
DOI：
10.1016/j.athoracsur.2016.06.085
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Hughes,GChad
中科院分区：
文献类型：
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作者：
Iribarne,Alexander;Keenan,Jeffrey;Benrashid,Ehsan;Wang,Hanghang;Meza,JamesM;Ganapathi,Asvin;Gaca,JeffreyG;Kim,HanW;Hurwitz,LynneM;Hughes,GChad
背景 目前近端主动脉修复术后影像学监测指南没有证据基础。本研究旨在描述近端主动脉手术后再干预的发生率和原因，以提供数据来指导术后监测的频率和持续时间。方法前瞻性收集了 9 年期间（n = 869）在单个机构接受近端主动脉手术（上行，带或不带根部，带或不带主动脉瓣置换，或带或不带弓）的所有患者的数据。确定需要对近端或远端主动脉进行再干预的患者，并确定再干预的原因。计划中的两阶段修复和在其他医院进行的索引手术被排除在外。主要终点是第一次再干预的时间，并使用竞争风险 Cox 回归来模拟再干预风险。结果 4.3% 的患者 (n = 37) 发生再干预，其中 48.6% (n = 18) 涉及近端主动脉，51.4% (n = 19) 涉及远端主动脉。再次干预的中位时间为 2.8 年（四分位数范围，1.5 至 3.6 年）。对于指数动脉瘤病例，最常见的是降主动脉/胸腹主动脉和根部动脉瘤的再干预。在 6 个根部动脉瘤/假性动脉瘤中，5 个（83%）是由于无支架猪主动脉根部变性所致。对于 A 型夹层，最常见的是降主动脉/胸腹主动脉和弓部动脉瘤的再干预。平均随访时间为 4.2 ± 2.5 年。 9 年精算免再干预率为 92.9%。 Cox 回归显示指数 A 型夹层是主动脉再干预时间的显着预测因素（风险比，2.01；95% 置信区间，1.04 至 3.9；p= 0.038）。大多数发生在索引手术后 3 年内，几乎同等程度地累及近端和远端主动脉。 A 型夹层或无支架猪根的患者需要积极监测，而更宽松的方法适合没有此类危险因素的患者。这一策略可以减少终生辐射负担和医疗保健费用。
BackgroundCurrent guidelines for imaging surveillance after proximal aortic repair are not evidence based. This study sought to characterize the incidence and causes of reintervention after proximal aortic operations to provide data to guide the frequency and duration of postoperative surveillance.MethodsData on all patients undergoing proximal aortic operations (ascending, with or without root, with or without aortic valve replacement, or with or without arch) during a 9-year period (n = 869) at a single institution were prospectively collected. Patients who required reintervention on the proximal or distal aorta were identified and causes for reintervention determined. Planned two-stage repairs and index procedures done at other hospitals were excluded. The primary end point was the time to the first reintervention, and competing-risk Cox regression was used to model reintervention risk.ResultsReinterventions occurred in 4.3% of patients (n = 37), with 48.6% (n = 18) involving the proximal aorta and 51.4% (n = 19) the distal. Median time to reintervention was 2.8 years (interquartile range, 1.5 to 3.6 years). For index aneurysm cases, reintervention for aneurysm of the descending/thoracoabdominal aorta and root were most common. Of the 6 root aneurysms/pseudoaneurysms, 5 (83%) were due to degeneration of a stentless porcine aortic root. For index type A dissections, reintervention for aneurysm of the descending/thoracoabdominal aorta and arch were most common. The mean duration of follow up was 4.2 ± 2.5 years. The 9-year actuarial freedom from reintervention was 92.9%. Cox regression showed index type A dissection was a significant predictor of time to aortic reintervention (hazard ratio, 2.01; 95% confidence interval, 1.04 to 3.9;p= 0.038).ConclusionsReinterventions after proximal aortic operations are uncommon; most occur within 3 years of the index operation and involve the proximal and distal aorta nearly equally. Patients with type A dissection or stentless porcine roots require aggressive surveillance, whereas a more liberal approach is suitable for patients without such risk factors. This strategy may reduce the lifetime radiation burden and health care costs.