经过急性甲型大动脉解剖的修复后的远端再手术-发病率,原因和结果
Igor Vendramin1, Daniela Piani1, Andrea Lechiancole1
1Azienda Sanitaria Universitaria Friuli Centrale, Cardiothoracic Department, Via Pozzuolo 11, 33100 Udine, Italy.
Reviews in cardiovascular medicine
|July 30, 2024
概括
对急性A型大动脉剖析 (A-AAD) 的广泛初始修复显著减少了重复手术. 这种方法提供了更好的中期存活率,特别是对于年轻的患者,应该考虑在经验丰富的中心.
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
- 大动脉疾病管理管理
背景情况:
- 对于急性A型大动脉解剖 (A-AAD) 的最佳手术策略仍在争论中,特别是关于大动脉门修复的程度.
- 在A-AAD的初始修复中包括大动脉门置换的必要性是长期结果的关键考虑.
研究的目的:
- 评估广泛的大动脉修复,包括大动脉门置换,是否可以防止A-AAD患者的重新手术.
- 为了比较A-AAD全门置换和全门置换的患者之间的重新手术率和生存结果.
主要方法:
- 对285名在1977年至2018年期间接受修复的A-AAD患者进行了回顾性分析.
- 两组结果的比较:上升性大动脉/血门置换 (n=226) 和上升性大动脉/门置换 (n=59).
- 分析重点关注的是远端再手术,胸部内血管支架和长期存活率.
主要成果:
- 远端重新手术在全弓组 (22 位患者) 比全弓组 (0 位患者) 显著更常见 (p < 0.001).
- 医院死亡率是14%的hemiarch组相对于0%的全门组 (p=0.3).
- 在5年和10年的精算生存率为68-62%的hemiarch组相对于100%的全弧组 (p=0.076).
结论:
- 在A-AAD修复后的远端重新手术与可接受的死亡率有关,但重新干预的比例更高.
- 广泛的初始修复,包括大动脉门,证明了较低的复手率和改善的中期生存率.
- 建议对A-AAD进行广泛的初始修复策略,特别是在经验丰富的手术中心治疗的年轻患者.
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