Influence of residual primary entry following the tear-oriented strategy for acute type A aortic dissection
Influence of residual primary entry following the tear-oriented strategy for acute type A aortic dissection
复制标题
急性 A 型主动脉夹层撕裂导向策略后残余主入口的影响
DOI：
10.1093/ejcts/ezab456
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Adachi H
中科院分区：
文献类型：
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作者：
Kawahito K;Aizawa K;Kimura N;Yamaguchi A;Adachi H
注意事项尽管撕裂导向策略有助于改善急性A型主动脉夹层（ATAAD）的短期手术结局，但尚未充分研究下游主动脉中残留入口撕裂的长期临床影响。本研究的目的是评估ATAAD的长期手术结果，有或没有残余入口撕裂在下游aortic.METHODSMedical记录的1107例ATAAD谁接受了紧急手术在1990年和2018年之间进行了回顾性分析。基线策略采用了以眼泪为导向的范例。切除入口撕裂的837例患者组成切除组，残留入口撕裂的270例患者组成残留组。在这些患者中，每组252例采用倾向评分匹配进行分析，并比较有或无残留入路的长期结局。两组间5年和10年生存率无显著差异：切除组分别为83.8%和68.5%，残留组分别为80.2%和66.5%（P= 0.600）。然而，下游主动脉的残留入口影响远端主动脉无事件生存率（5年和10年时，切除组分别为90.4%和80.6%，残留组分别为82.3%和67.4%;P= 0.003）。此外，1107例患者的多变量风险分析证实，在下游主动脉的残留条目是远端主动脉events. CONCLUSIONSThear导向的策略仍然是高风险患者的金标准，但是，广泛的操作可能会被认为是稳定的患者，以减少长期的主动脉事件的风险因素。
OBJECTIVESAlthough a tear-oriented strategy has contributed to improving short-term surgical outcomes of acute type A aortic dissection (ATAAD), long-term clinical influences of residual entry tear in the downstream aorta have not been fully investigated. The goal of this study was to assess the long-term surgical outcomes of ATAAD with or without a residual entry tear in the downstream aorta.METHODSMedical records of 1107 patients with ATAAD who underwent emergency surgery between 1990 and 2018 were retrospectively reviewed. A tear-oriented paradigm was adopted for the baseline strategy. The 837 patients in whom the entry tears were resected comprised the resected group, and the 270 patients with a residual entry tear comprised the residual group. Of these patients, 252 in each group were analysed using propensity score matching, and long-term outcomes were compared with or without residual entry.RESULTSHospital deaths were lower in the resected group (3.2% vs 8.3%;P= 0.020). The survival rate was not significantly different between the groups: It was 83.8% and 68.5% in the resected group and 80.2% and 66.5% in the residual group at 5 and 10 years, respectively (P= 0.600). However, residual entry in the downstream aorta affected the distal aortic event-free survival rate (90.4% and 80.6% in the resected group and 82.3% and 67.4% in the residual group at 5 and 10 years, respectively;P= 0.003). Furthermore, multivariable risk analysis of 1107 patients confirmed that a residual entry in the downstream aorta was a risk factor for distal aortic events.CONCLUSIONSThe tear-oriented strategy remains the gold standard for high-risk patients; however, the extensive operation might be considered for stable patients to reduce long-term aortic events.