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在急性A型大动脉剖析修复后下降大动脉的命运
Wan Kee Kim1, Tae-Hoon Kim2, Ha Lee3
1Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
Journal of thoracic disease
|December 13, 2023
概括
在急性A型大动脉解剖后,下降性大动脉扩张的修复在经典和逆行延伸类型中比内腔血瘤更快. 在上胸前动脉的撕裂位置增加扩张和事件的风险.
科学领域:
- 心血管外科心血管外科
- 胸前大动脉疾病 胸前大动脉疾病
- 大动脉切割 动脉切割
背景情况:
- 在急性A型AD (TAAD) 修复后,关于残留下降大动脉剖析 (AD) 的数据有限.
- 了解下降大动脉的长期命运对于患者管理至关重要.
研究的目的:
- 评估急性TAAD修复后下降大动脉的扩张率和大动脉事件.
- 为了确定与下降大动脉并发症相关的风险因素.
主要方法:
- 对299名接受急性TAAD修复的患者 (2009-2018) 的回顾性审查.
- 排除患有遗传性大动脉损伤或并发性下降大动脉手术的患者.
- 分类为经典的TAAD,逆行扩展 (Retro) 和室内血瘤 (IMH) 组.
- 对下降性大动脉扩张率和大动脉事件 (修复,干预,破裂) 的分析.
主要成果:
- 与IMH组相比,复古和经典组的下降性大动脉扩张速度更快.
- 对大动脉事件的未调整风险在Retro组与IMH和Classic组相比显著更高.
- 多变量分析显示,胸前前动脉上部 (T7以上) 的亲密撕裂位置是大动脉扩张和事件的显著预测因素.
结论:
- 与IMH相比,经典TAAD和逆行扩张的患者的下降大动脉扩张更快.
- 亲密撕裂的位置,特别是在上胸前动脉中,是影响下降动脉结果的关键因素.
- 在TAAD修复后的患者中,需要对下降性大动脉进行密切监测和评估.
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