在60岁或更年轻的患者中进行DeBakey1型大动脉剖析的大动脉门手术
Fausto Biancari1,2, Javier Rodriguez Lega3, Giovanni Mariscalco4
1Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
BJS open
|May 20, 2024
概括
对于患有DeBakey1型大动脉剖析的年轻患者来说,与上升大动脉修复相比,全大动脉门修复并没有降低重新手术率. 上升大动脉修复为这个患者群体提供了令人满意的早期和中期结果.
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
- 大动脉剖析研究研究
背景情况:
- 延长的大动脉修复对于DeBakey1型大动脉剖析手术的长期耐用性至关重要.
- 年轻的患者 (<60岁) 面临较高的风险的大动脉退行由于更长的预期寿命.
- 研究年轻患者的大动脉手术的早期结果和持久性至关重要.
研究的目的:
- 在60岁以下的DeBakey1型大动脉剖析患者中,比较上升大动脉修复与全大动脉门修复的早期结果和持久性.
- 为了评估在不同外科手术方法后对远端主动脉进行重新手术的5年累积发病率.
- 评估手术技术对术后并发症和死亡率的影响.
主要方法:
- 在18个欧洲中心 (2005-2021) 对60岁以下接受急性DeBakey1型大动脉剖析手术修复的患者进行分析.
- 手术修复包括上升大动脉修复或全大动脉门修复 (传统或冷大象干技术).
- 主要结局:远端大动脉再手术的5年累积发病率;次要结局:中风,透析,死亡率.
主要成果:
- 整体大动脉门修复与上升大动脉修复相比,并没有降低5年远部大动脉复手率 (6.7%对6.7%).
- 整体大动脉门修复与术后中风/全球脑缺血 (25.7%对18.4%) 和透析 (19.6%对12.7%) 的增加率有关.
- 在这两种手术方法中,五年死亡率是可比的 (22.8%对27.3%).
结论:
- 整体大动脉门置换并没有减少5年后远端大动脉手术的发生率,在DeBakey型1大动脉剖析的年轻患者中.
- 上升性大动脉修复,当可行时,证明了DeBakey1型大动脉剖析的早期和中期结果令人满意.
- 上升性大动脉修复可能是接受DeBakey1型大动脉剖析手术修复的选定年轻患者的首选策略.
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