Reoperative surgery on the thoracoabdominal aorta.
Reoperative surgery on the thoracoabdominal aorta.
复制标题
胸腹主动脉再次手术。
DOI：
10.1016/j.jtcvs.2017.08.024
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
S. Lemaire
中科院分区：
文献类型：
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作者：
J. Coselli;C. Rosu;Hiruni S. Amarasekara;S. Green;Qianzi Zhang;M. D. Price;S. Lemaire
目的：自从主动脉动脉瘤的血管内修复技术出现以来，许多中心认为这些患者因先前的手术而具有“高风险”，因此证明了血管内入路对先前开放的远端主动脉修复患者的应用是合理的。我们试图确定胸腹主动脉瘤（TAAA）再手术修复的患者是否比非再手术修复的患者预后更差。方法回顾1986 - 2016年3379例TAAA修复的数据。我们比较了再手术（n = 726）和非再手术（n = 2653）患者的术前特征、手术变量和结果。此外，我们检查了再手术指征，以确定因修复失败而进行的修复（n = 93）和作为邻近扩展修复而进行的再手术（n = 633）。通过术前和术中相关因素进行多变量分析，以确定不良事件的预测因素。结果两组患者手术死亡率无显著差异（再手术组为8.1%，非再手术组为7.3%，P= 0.5）；此外，再手术修复与不良事件风险增加无关。然而，Kaplan-Meier生存分析显示，在前10年，再手术组的预后明显差于非手术组（P< 0.001）（10年生存率：修复失败患者为23.9%±4.9%，延长修复患者为28.4%±2.0%，非手术修复患者为40.1%±1.1%）。结论：我们无法发现再手术和非再手术TAAA修复的早期结果有显著差异。然而，中期结果显示再手术患者的生存率较差。
ObjectiveSince the advent of endovascular repair for aortic aneurysms, many centers have justified the use of endovascular approaches in patients with previous open distal aortic repair by deeming these patients “high risk” because of their previous operation. We sought to determine whether patients who undergo reoperative repair for thoracoabdominal aortic aneurysm (TAAA) have worse outcomes than patients who undergo non-reoperative repair.MethodsWe reviewed our data on 3379 TAAA repairs from 1986 to 2016. We compared patients' preoperative characteristics, surgical variables, and outcomes among reoperative (n = 726) and non-reoperative (n = 2653) cases. Furthermore, we examined reoperative indications to identify repairs performed because of repair failure (n = 93) and reoperations performed as an adjacent extension of repair (n = 633). A multivariable analysis was conducted to identify predictors of adverse events by using relevant preoperative and intraoperative factors.ResultsThe operative mortality rate did not significantly differ between groups (8.1% for reoperative vs 7.3% for non-reoperative;P= .5); in addition, reoperative repair was not associated with an increased risk of adverse event. However, Kaplan-Meier survival analysis showed that over the first 10 years, the reoperative groups fared significantly worse than the non-reoperative group (P< .001) (survival estimates at 10 years: 23.9% ± 4.9% for patients with repair failure, 28.4% ± 2.0% for those with extension of repair, and 40.1% ± 1.1% for non-reoperative repairs).ConclusionsWe were unable to detect noteworthy differences in early outcomes between reoperative and non-reoperative TAAA repair. However, mid-term results indicate worse survival for patients who undergo reoperative surgery.