Surgical treatment of ascending aortic aneurysms in patients with giant cell aortitis
Surgical treatment of ascending aortic aneurysms in patients with giant cell aortitis
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DOI：
10.1016/j.athoracsur.2004.10.039
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发表时间：
2005-05-01
影响因子：
4.6
通讯作者：
Schaff, HV
中科院分区：
文献类型：
--
作者：
Zehr, KJ;Mathur, A;Schaff, HV
背景。尽管巨细胞动脉炎是血管炎的常见原因，但巨细胞动脉炎是一种罕见的升主动脉瘤疾病。我们评估了8年的手术修复经验，包括术前变量、疾病程度、所需的外科手术以及发生额外大血管动脉瘤的倾向。1995 ~ 2002年共手术37例，其中女29例，男8例，年龄69.6±9.5岁。10例（27%）患者在8.9 +/- 3.9年前曾因颞动脉炎或风湿性多肌痛接受类固醇治疗。19例（51%）患者主动脉瓣反流+3或+4。最大动脉瘤大小为6.1±0.8 cm。30例（81%）患者接受了聚对苯二甲酸乙二醇酯纤维（涤纶）管移植替代升主动脉，4例（11%）患者接受了改良的Bentall手术，2例（5%）患者接受了保留瓣膜的主动脉根部重建，1例（3%）患者接受了主动脉切开。22例（59%）患者因出血或完全主动脉弓置换术需要22 +/- 9分钟的低温循环停搏。26例（70%）患者同时进行了心脏手术。没有早期死亡。再次发现出血3例（8%），中风3例（8%），左声带麻痹2例（5%），肾功能衰竭2例（5%），胃肠道出血1例（3%）。平均随访时间为2.8±2.3年。四年精算生存率为74%（95%置信区间，57%至94%）。17例（46%）患者发生其他降主动脉或腹主动脉或大血管动脉瘤。4例患者既往有动脉瘤手术，8例患者有动脉瘤监测，5例患者在随访期间进行了动脉瘤修复。8例晚期死亡中，3例由胸降性动脉瘤并发症引起。没有患者需要更换在初始手术过程中保留的原生主动脉瓣。由巨细胞性主动脉炎引起的升主动脉瘤可累及从主动脉根部到主动脉弓的主动脉，因此需要有针对性的手术入路。主动脉瓣组织免于病理过程。近一半的患者会出现主动脉和大血管的其他动脉瘤。对剩余主动脉的频繁监测是必须的。(c) 2005年，胸外科医生协会。
Background. Giant cell aortitis is a rare cause of ascending aortic aneurysm disease despite giant cell arteritis being a common cause of vasculitis. We evaluated an 8-year experience with surgical repair with regard to preoperative variables, extent of disease, required surgical procedures, and the propensity to develop additional great vessel aneurysms.Methods. Thirty-seven patients (29 female, 8 male; aged 69.6 +/- 9.5 years) were operated on from 1995 to 2002. Ten (27%) patients had a history of steroid treatment for temporal arteritis or polymyalgia rheumatica 8.9 +/- 3.9 years before. Nineteen (51%) patients had +3 or +4 aortic regurgitation. Maximal aneurysm size was 6.1 +/- 0.8 cm. Thirty (81%) patients underwent polyethylene terephthalate fiber (Dacron) tube graft replacement of the ascending aorta, 4 (11%) had a modified Bentall procedure, 2 (5%) had a valve-sparing aortic root reconstruction, and 1 (3%) had aortorrhaphy. Twenty-two (59%) patients required 22 +/- 9 minutes of hypothermic circulatory arrest for hemiarch or complete aortic arch replacement. Twenty-six (70%) patients had concomitant cardiac procedures.Results. There was no early mortality. Morbidity was reexploration for bleeding in 3 (8%) patients, stroke in 3 (8%), left vocal cord paralysis in 2 (5%), renal failure in 2 (5%), and gastrointestinal bleeding in 1 (3%). Mean follow-up was 2.8 +/- 2.3 years. Four-year actuarial survival was 74% (95% confidence interval, 57% to 94%). Other descending or abdominal aortic or great vessel aneurysms occurred in 17 (46%) patients. Four patients had prior aneurysm surgery, 8 are monitored with aneurysms, and 5 underwent repair of an aneurysm in the follow-up period. Of 8 late deaths, 3 were caused by complications of a descending thoracic aneurysm. No patient required replacement of a native aortic valve that was preserved during the initial operative procedure.Conclusions. Ascending aortic aneurysms caused by giant cell aortitis can involve the aorta from the aortic root through the aortic arch, thus requiring a tailored operative approach. The aortic valve tissue is spared from the pathologic process. Other aneurysms of the aorta and great vessels occur in nearly half of patients. Frequent surveillance of the remaining aorta is mandatory. (c) 2005 by The Society of Thoracic Surgeons.