Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm
Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm
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DOI：
10.1093/icvts/ivx031
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发表时间：
2017-06-01
影响因子：
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通讯作者：
Adachi, Hideo
中科院分区：
文献类型：
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作者：
Hori, Daijiro;Okamura, Homare;Adachi, Hideo
目的：随着血管内覆膜支架技术的引入，主动脉瘤患者有多种手术选择。我们试图评估接受腔内和开放手术修复非夹层主动脉弓aneurysm.METHODS的患者的早期和中期结局：总体而言，200例患者接受了治疗孤立的非夹层主动脉弓aneurysm 2008年1月至2016年2月：133例患者接受了开放手术和67，腔内修复。结果：70%（n = 47）需要腔内修复的患者接受了开孔型覆膜支架，30%（n = 20）接受了去分支技术。开放手术组的患者更年轻（71岁vs 75岁，P < 0.001），缺血性心脏病的患病率更低（11% vs 35%，P < 0.001）。腔内修复组的重症监护室住院时间（1 vs 3天，P < 0.001）、住院时间（11 vs 17天，P < 0.001）和手术时间（208 vs 390 min，P < 0.001）均低于开放手术组。开放手术组和血管内治疗组各有3例院内死亡（分别为2% vs 5%，P = 0.40）。开放手术组的中期生存率（P < 0.001）和无再次介入率（P = 0.009）优于腔内修复组。未观察到药物相关死亡。倾向匹配比较（n = 58）表明，开放手术组的生存率更好（P = 0.011）;再次介入率无显著差异（P = 0.28）。结论：对再次介入进行密切随访可降低血管内修复术相关死亡的风险，并为接受血管内修复术的患者提供可接受的结局。
OBJECTIVES: With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm.METHODS: Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared.RESULTS: Seventy percent (n = 47) needing endovascular repair underwent fenestrated stent graft and 30% (n = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P < 0.001). Intensive care unit stay (1 vs 3 days, P < 0.001), hospital stay (11 vs 17 days, P < 0.001) and surgical time (208 vs 390 min, P < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P = 0.40). Mid-term survival (P < 0.001) and freedom from reintervention (P = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison (n = 58) demonstrated that survival was better in the open surgery group (P = 0.011); no significant difference was seen in the reintervention rate (P = 0.28).CONCLUSIONS: Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.