Reoperative aortic root and transverse arch procedures: A comparison with contemporaneous primary operations
Reoperative aortic root and transverse arch procedures: A comparison with contemporaneous primary operations
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DOI：
10.1016/j.jtcvs.2007.11.071
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发表时间：
2008-10-01
影响因子：
6
通讯作者：
Griepp, Randall B.
中科院分区：
文献类型：
--
作者：
Etz, Christian D.;Plestis, Konstadinos A.;Griepp, Randall B.
目的：根/升主动脉和横弓再手术后的长期生存率和影响结果的风险因素尚未明确描述。男性138例;年龄，60 +/-15岁）接受再次手术的根部/升主动脉（n = 100）或横弓（n = 100）从1998年1月至2004年12月，我们在我们的机构进行了手术，并与480例同期的初次手术患者进行了比较（323例男性患者;年龄62 ± 16岁; 335例近端主动脉和145例横弓手术）。再次近端主动脉手术的住院死亡率（7%）高于原发性根部/升主动脉手术（3%），但初次和再次手术后的手术死亡率差异较小（9%对10%）。对根部/升主动脉手术和主动脉弓手术的单独多变量分析显示，慢性阻塞性肺疾病和年龄是两种手术后死亡的重要风险因素。此外，射血分数低于30%对近端主动脉手术构成显著风险，糖尿病和非选择性手术预测弓手术后预后较差。对于根部/升主动脉手术的幸存者，再次手术和初次手术的长期结局无显著差异，对于年龄和性别匹配的正常人群，两者均将寿命恢复至预期水平。接受弓手术的患者，但是，继续有一个贫穷的长期前景比他们正常peer.Conclusions：在这个系列中，再手术在横弓进行同样的风险，初级弓程序，但较高的手术死亡率是看到与再手术比与初级根/升主动脉程序。接受根部/升支手术的患者的长期前景优于接受主动脉弓手术的患者，初次手术与再次手术患者的寿命无差异。
Objectives: Long-term survival and risk factors affecting outcome after reoperative root/ascending aorta and transverse arch procedures have not been clearly described.Methods: Two hundred patients (138 male patients; age, 60 +/- 15 years) underwent reoperative root/ascending aorta (n = 100) or transverse arch (n = 100) procedures at our institution from January 1998 to December 2004 and were compared with 480 consecutive contemporaneous patients with primary procedures (323 male patients; age, 62 +/- 16 years; 335 proximal aorta and 145 transverse arch procedures).Results: Reoperative proximal aorta procedures had a higher hospital mortality (7%) than primary root/ascending aorta procedures (3%), but there was a less dramatic difference in operative mortality after primary and reoperative arch procedures (9% vs 10%). Separate multivariable analyses of root/ascending aorta procedures and arch procedures revealed chronic obstructive pulmonary disease and age to be significant risk factors for death after either procedure. In addition, an ejection fraction of less than 30% posed a significant risk for proximal aortic surgery, and diabetes and nonelective operations predicted poorer outcome after arch operations. For survivors of root/ascending aorta operations, there was no significant difference in long-term outcome between reoperations and primary procedures, with both restoring longevity to expected levels for an age-and sex-matched normal population. Patients undergoing arch operations, however, continued to have a poorer long-term outlook than their normal peers.Conclusions: In this series, reoperations in the transverse arch carry the same risk as primary arch procedures, but a higher operative mortality is seen with reoperative than with primary root/ascending aorta procedures. The long-term outlook is better for patients undergoing root/ascending operations than for patients undergoing aortic arch operations, with no difference in the longevity of patients undergoing primary procedures versus reoperations.