Impact of shaggy aorta on outcomes of open thoracoabdominal aortic aneurysm repair
Impact of shaggy aorta on outcomes of open thoracoabdominal aortic aneurysm repair
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DOI：
10.1016/j.jtcvs.2019.07.112
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发表时间：
2020-10-01
影响因子：
6
通讯作者：
Okita, Yutaka
中科院分区：
文献类型：
--
作者：
Yokawa, Koki;Ikeno, Yuki;Okita, Yutaka
背景：本研究的目的是评估弥漫性主动脉粥样硬化相关血栓形成或“毛茸茸的主动脉”对开胸腹主动脉瘤修复术（TAAA）结果的影响。方法：从 1999 年 10 月至 2018 年 3 月，251 名患者采用分段主动脉钳夹术接受了开腹 TAAA 修复术。 28 名患者（11.2%）接受了紧急或紧急手术。患者被分为 3 组：夹层动脉瘤（139 例患者，55.4%）、不伴有毛茸茸主动脉的退行性动脉瘤（76 例患者，30.3%）和伴有毛茸茸主动脉的退行性动脉瘤（36 例患者，14.3%）。使用增强计算机断层扫描对毛茸茸的主动脉进行评估，并将其定义为动脉粥样硬化斑块厚度 >= 5 毫米且动脉粥样硬化斑块表面不规则的患者。平均随访时间为 4.3 +/- 4.1 年。结果：手术死亡率为 8%（20 名患者），25 名患者（10.0%）发生脊髓损伤，其中 16 名（6.4%）患有永久性神经功能障碍。主动脉毛茸茸的患者的手术死亡率明显更高（夹层：2.2%，非毛茸茸：6.6%，毛茸茸：33.3%，P < .001），而毛茸茸的主动脉是脊髓损伤的重要危险因素（夹层：7.2%，非毛茸茸：6.6%，毛茸茸：27.8%，P < .003）。多变量分析表明，毛茸茸的主动脉是手术死亡率、脊髓损伤和急性肾衰竭等复合结局的重要危险因素（比值比，4.78；95% 置信区间，1.91-12.3，P < .001）。结论：毛茸茸的主动脉术前增强计算机断层扫描评估可以预测开放 TAAA 修复术的高风险患者。
Background: The aim of this study was to evaluate the impact of diffuse aortic atherosclerosis-related thrombosis, or "shaggy aorta" on the outcomes of open thoracoabdominal aortic aneurysm repair (TAAA).Methods: From October 1999 to March 2018, 251 patients underwent open TAAA repair using segmental-staged aortic clamping. Twenty-eight patients (11.2%) received emergent or urgent operations. Patients were classified into 3 groups: dissection aneurysm (139 patients, 55.4%), degenerative aneurysm without shaggy aorta (76 patients, 30.3%), and degenerative aneurysm with shaggy aorta (36 patients, 14.3%). Shaggy aorta was assessed using enhanced computed tomography and defined as patients with atheroma thickness >= 5 mm with irregular atheroma surface. Mean follow-up was 4.3 +/- 4.1 years.Results: Operative mortality was 8 % (20 patients) and spinal cord injury occurred in 25 patients (10.0%), 16 of whom (6.4%) had permanent neurologic dysfunction. Operative mortality was significantly worse in patients with shaggy aorta (dissection: 2.2%, non-shaggy: 6.6%, and shaggy: 33.3%, P < .001) and shaggy aorta was a significant risk factor for spinal cord injury (dissection. 7.2%, non-shaggy: 6.6%, and shaggy: 27.8%, P < .003). Multivariable analysis demonstrated that shaggy aorta was a significant risk factor for composite outcome consisted of operative mortality, spinal cord injury, and acute renal failure (odds ratio, 4.78; 95% confidence interval, 1.91-12.3, P < .001).Conclusions: Preoperative enhanced computed tomography assessment of shaggy aorta could predict high-risk patients for open TAAA repair.