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上升大动脉和部分门置换的结果与入口切除对于DeBakey I型急性大动脉剖析的入口切除

Naoto Fukunaga¹, Tatsuto Wakami², Akio Shimoji²

¹Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-cho, Amagasaki, Hyogo, 660-8550, Japan. naotowakimachi@hotmail.co.jp.

General thoracic and cardiovascular surgery

|August 5, 2023

概括

与入口切除的上升性大动脉/部分门置换显示,与全门置换相比,DeBakey I型急性大动脉切割 (DIAAD) 修复的早期和晚期结果令人满意. 进入切除仍然是DIAAD的标准方法.

科学领域:

心血管外科心血管外科
胸部外科手术胸部外科手术
主动脉疾病主动脉疾病

背景情况:

德贝基I型急性大动脉解剖 (DIAAD) 是一种危及生命的疾病,需要复杂的手术修复.
对DIAAD的手术策略包括上升大动脉/部分门置换与入口切除和全门置换与入口切除.
将这些不同的手术方法的结果进行比较对于优化患者护理至关重要.

研究的目的:

研究和比较在DeBakey型I急性大动脉剖析 (DIAAD) 患者中,上升性大动脉/部分门置换与入口切除的早期和晚期临床结果与入口切除的全门置换.

主要方法:

这是一项追溯研究,对98名在2005年1月至2020年12月期间接受DIAAD修复的患者进行了追溯研究.
患者被分为两组:非全额门置换 (非TAR) 组 (上升大动脉/部分门置换与入口切除,n=74) 和全额门置换 (TAR) 组 (全额门置换与入口切除,n=24).
分析了包括医院死亡,术后并发症,生存率和重新干预率在内的结果,平均随访时间为4.8年.

主要成果:

与TAR组相比,非TAR组的医院死亡率相似,但术后永久的神经缺陷和临时血液透析的发生率明显较低.
五年生存率在两组之间是相似的 (95.1%非TAR与89.2%TAR).
在5年后,非TAR组 (87.8%) 与TAR组 (64.1%) 相比,无需下游大动脉相关的再干预显著更高.

结论:

与入口切除的上升大动脉/部分门置换在DIAAD修复中表现出令人满意的早期和晚期结果,主要的术后并发症发生率较低,与全门置换相比,重新干预的次数较少.
输入切除结合上升大动脉和/或大动脉的移植置换继续成为一种可行的和有效的标准方法来管理DeBakey I型急性大动脉剖析.

关键词:

德贝基型I急性大动脉剖析进入切除切除切除植入物替代植入物替代

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