Elective primary aortic root replacement with and without hemiarch repair in patients with no previous cardiac surgery
Elective primary aortic root replacement with and without hemiarch repair in patients with no previous cardiac surgery
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DOI：
10.1016/j.jtcvs.2016.10.076
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发表时间：
2017-06-01
影响因子：
6
通讯作者：
Green, Susan
中科院分区：
文献类型：
--
作者：
Preventza, Ourania;Coselli, Joseph S.;Green, Susan
目的：选择性主动脉根部置换术（ARR）已获得良好的结局。目前尚不清楚在低温停循环的情况下将修复延伸到近端主动脉弓是否会增加风险。我们研究了早期的结果，选择性，原发性ARR，有和没有半弓置换，在以前的cardiac surgery.Methods的患者：在4年的时间内，140非重做患者（中位年龄，54岁）进行了选择性，原发性ARR根动脉瘤; 119例（85%）有半弓置换，21（15%）只有升主动脉置换。41例（29.3%）进行了保留瓣膜的ARR，99例（70.7%）进行了瓣膜置换的ARR。118例（99%）半弓修复术采用中度低温停循环和顺行脑灌注。并发症包括暂时性肾透析（n = 1; 4.8%），一过性神经功能缺损（n = 2; 9.5%）和气管切开术（n = 2; 9.5%）在升主动脉修复术后和需要再次手术的出血（n = 4; 3.4%）、心包积液需要引流（n = 9; 7.6%）和半弓置换术后气管造口术（n = 2; 1.7%）。半弓组未观察到卒中（P = 0.022;单变量分析）。修复到近端弓的程度似乎并没有与任何不良反应。结论：在非重做患者中，选择性原发性ARR具有良好的早期结局，无论修复是否延伸到近端arch. Additional选择性半弓置换与中度低温停循环和顺行脑灌注神经系统并发症的风险较低，如果必要的话，应该进行。需要长期数据来比较近端主动脉弓置换或未置换患者主动脉弓再次介入的发生率。
Objective: Excellent outcomes have been established for elective aortic root replacement (ARR). It is less clear whether extending the repair into the proximal aortic arch with hypothermic circulatory arrest increases risk. We examined the early outcomes of elective, primary ARR, with and without hemiarch replacement, in patients without previous cardiac surgery.Methods: Over a 4-year period, 140 non-redo patients (median age, 54 years) underwent elective, primary ARR for root aneurysms; 119 patients (85%) had hemiarch replacement, and 21 (15%) had only ascending aortic replacement. Valve-sparing ARR was performed in 41 cases (29.3%) and valve-replacing ARR in 99 (70.7%). Moderate hypothermic circulatory arrest and antegrade cerebral perfusion were used in 118 (99%) hemiarch repairs.Results: There were no operative deaths or permanent strokes. Complications included temporary renal dialysis (n = 1; 4.8%), transient neurologic deficit (n = 2; 9.5%), and tracheostomy (n = 2; 9.5%) after ascending aortic repair and bleeding requiring reoperation (n = 4; 3.4%), pericardial effusion requiring drainage (n = 9; 7.6%), and tracheostomy (n = 2; 1.7%) after hemiarch replacement. No stroke was observed in the hemiarch group (P =.022; univariate analysis). The extent of the repair into the proximal arch did not appear to be associated with any adverse effect.Conclusions: In non-redo patients, elective primary ARR has excellent early outcomes, regardless of whether repair extends into the proximal arch. Additional elective hemiarch replacement with moderate hypothermic circulatory arrest and antegrade cerebral perfusion has a low risk of neurologic complications and should be performed if necessary. Long-term data are needed to compare the rates of reintervention in the aortic arch in patients with or without proximal arch replacement.