Thoracic endovascular aortic repair for acute complicated type B aortic dissection: Superiority relative to conventional open surgical and medical therapy
Thoracic endovascular aortic repair for acute complicated type B aortic dissection: Superiority relative to conventional open surgical and medical therapy
复制标题
DOI：
10.1016/j.jtcvs.2010.06.024
复制
发表时间：
2010-12-01
影响因子：
6
通讯作者：
Szeto, Wilson Y.
中科院分区：
文献类型：
--
作者：
Zeeshan, Ahmad;Woo, Edward Y.;Szeto, Wilson Y.
目的：本研究比较胸主动脉腔内修复术与传统开放手术及药物治疗急性复杂性B型主动脉夹层的疗效。方法：从2002年至2010年，从宾夕法尼亚大学主动脉数据库中回顾性筛选出170例B型主动脉夹层患者。在这 170 名患者中，147 名患有急性 B 型主动脉夹层（无并发症 70 名，复杂 77 名）。对于急性复杂B型主动脉夹层患者，治疗包括胸主动脉腔内修复术（A组）或常规开放手术及药物治疗（B组）。 结果：77例急性复杂B型主动脉夹层患者中，45例（59%）接受胸主动脉腔内修复术（A组）。 B 组中，20 名患者（26%）接受了开放手术修复，12 名患者（15%）接受了药物治疗。与传统治疗（开放手术修复 n = 8、40%，药物治疗 n = 4、33%，P = .006）相比，胸主动脉腔内修复术可降低院内死亡率或 30 天死亡率（n = 2, 4%）。 A 组（胸主动脉腔内修复术）患者在 1 年、3 年和 5 年时的生存率持续显着提高（A 组：82%、79% 和 79%，B 组：58%、52% 和 44%，P = 0.008）。结论：与常规治疗相比，胸主动脉腔内修复术治疗急性复杂性 B 型夹层与优良的早期结果和改善的中期生存率相关。在得出明确结论之前，需要更长时间的随访来证明生存益处。 （胸心血管外科杂志 2010 年；140：S109-15）
Objective: This study compared outcomes between thoracic endovascular aortic repair and conventional open surgical and medical therapies for acute complicated type B aortic dissection.Methods: From 2002 to 2010, a total of 170 patients with type B aortic dissections were retrospectively identified from the University of Pennsylvania aortic database. Of these 170 patients, 147 had acute type B aortic dissections (uncomplicated 70, complicated 77). For patients with acute complicated type B aortic dissections, management included thoracic endovascular aortic repair (group A) or conventional open surgical and medical therapies (group B).Results: In the 77 patients with acute complicated type B aortic dissections, thoracic endovascular aortic repair (group A) was performed in 45 patients (59%). In group B, 20 patients (26%) underwent open surgical repair and 12 (15%) had their conditions managed with medical therapy. Thoracic endovascular aortic repair was associated with lower in-hospital or 30-day mortality (n = 2, 4%) than conventional therapy (open surgical repair n = 8, 40%, medical therapy, n 4, 33%, P = .006). Patients in group A (thoracic endovascular aortic repair) continued to show significantly improved survival at 1, 3, and 5 years (group A: 82%, 79%, and 79% vs group B: 58%, 52%, and 44%, P = .008).Conclusions: Thoracic endovascular aortic repair for acute complicated type B dissection is associated with superior early outcome and improved midterm survival relative to conventional therapy. Longer follow-up demonstrating survival benefit is needed before definitive conclusion can be made. (J Thorac Cardiovasc Surg 2010;140:S109-15)