Distal Aortic Progression After Hemiarch, Zones 1-3 Arch Replacement in Acute Type A Aortic Dissection.
Distal Aortic Progression After Hemiarch, Zones 1-3 Arch Replacement in Acute Type A Aortic Dissection.
复制标题
急性 A 型主动脉夹层半弓、1-3 区弓形置换后的远端主动脉进展。
DOI：
10.1016/j.athoracsur.2022.10.035
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Yang,Bo
中科院分区：
文献类型：
--
作者：
Graham,NathanJ;Titsworth,Marc;Ahmad,Rana-Armaghan;Wu,Xiaoting;Naeem,Aroma;Kim,KarenM;Fukuhara,Shinichi;Patel,Himanshu;Deeb,GMichael;Yang,Bo
背景：急性A型主动脉夹层（ATAAD）患者的主动脉弓修复程度存在争议。方法1996年至2021年，756例ATAAD患者行开放弓置换术。该队列分为半弓组（n = 481）、1区组（n = 65）、2区组（n = 148）和3区组（n = 62）。使用术后间隔期计算机断层扫描或远端主动脉磁共振成像数据模拟主动脉生长的跨组比较。结果除出血组冠心病发生率高、卒中发生率低外，统计学差异无统计学意义。术中，1区、2区和3区比出血组有更多的体外循环、交叉钳和低温循环停搏次数，需要更多的术中输血。各组围手术期预后相似，但3区因出血再次手术较多。10年累计再手术发生率为出血，16.7%；第1区，16.3%；2区，21.5%；3区为17.6% （P= 0.70）。10年生存率相似：出血66%；1区，60.3%；2区，68.0%)；3区66.1% （P= 0.20）。主动脉弓、降主动脉和腹主动脉的生长速率在10年内各组间无显著差异。在整个队列中，主动脉弓随时间的增长速度为每年0.38 mm (P< 0.001)，降主动脉每年0.84 mm (P< 0.001)，腹主动脉每年0.69 mm （P< 0.001）。结论颅内出血或1、2、3区主动脉置换术后，远端动脉瘤的长期生存率、远端主动脉生长或再手术率无显著差异。对于所有ATAAD患者，可以采用患者特异性的弓置换策略，而不是默认的主动弓置换。
BackgroundThere is debate regarding aortic arch repair extent for acute type A aortic dissection (ATAAD) patients.MethodsFrom 1996 to 2021, 756 ATAAD patients underwent open arch replacement. The cohort was divided into hemiarch (n = 481), zone 1 (n = 65), zone 2 (n = 148), and zone 3 (n = 62) arch replacement groups. Cross-group comparison of aortic growth was modeled using data from interval postoperative computed tomography or magnetic resonance imaging of the distal aorta.ResultsDemographics were not significantly different except the hemiarch group had more coronary artery disease and less stroke. Intraoperatively, zones 1, 2, and 3 had greater cardiopulmonary bypass, cross-clamp, and hypothermic circulatory arrest times and required more intraoperative blood transfusion than the hemiarch group. Perioperative outcomes were similar among groups except zone 3 had more reoperation for bleeding. Ten-year cumulative incidence of reoperation was hemiarch, 16.7%; zone 1, 16.3%; zone 2, 21.5%; and zone 3, 17.6% (P= .70). Ten-year survival was similar: hemiarch, 66%; zone 1, 60.3%; zone 2, 68.0%); and zone 3 66.1% (P= .20). Aortic arch, descending aorta, and abdominal aorta growth rates were not significantly different among groups over 10 years. In the whole cohort, the growth rate over time for aortic arch was 0.38 mm per year (P< .001), descending aorta 0.84 mm per year (P< .001), and abdominal aorta 0.69 mm per year (P< .001).ConclusionsThere was no significant difference in long-term survival, distal aorta growth, or reoperation rate for distal aortic aneurysm after hemiarch or zones 1, 2, or 3 arch replacement. Patient-specific arch replacement strategies may be used rather than defaulting to aggressive arch replacement for all ATAAD patients.