在之前的心脏手术或A型大动脉剖析修复后进行重复性大动脉根置换
Eilon Ram1, Christopher Lau1, Arnaldo Dimagli1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
The Journal of thoracic and cardiovascular surgery
|August 26, 2024
概括
重复手术大动脉根置换 (ARR) 将主要不良事件的风险增加3.5倍,但与初级ARR相比,手术死亡率没有差异. 再次手术的患者有更多的并发症和广泛的大动脉疾病.
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
- 大动脉外科手术
背景情况:
- 重生性大动脉根置换 (ARR) 带来了重大的技术挑战.
- 之前的急性A型大动脉剖析修复是复手性ARR的特定指示.
研究的目的:
- 评估重复手术对大动脉根置换后的结果的影响.
- 为了比较原发性和再手术性ARR之间的结果,特别是在先前有急性A型大动脉剖析修复的患者中.
主要方法:
- 对1823名接受ARR治疗的患者进行了回顾性分析.
- 对1592名初级ARR患者和231名再手术ARR患者的结果进行比较.
- 根据先前的急性A型大动脉剖析修复,在复手性ARR组内的子组分析.
主要成果:
- 再手术的ARR患者患病率更高,包括缺血性心脏病,糖尿病,慢性肺病和功能障碍.
- 重复手术的ARR与重大不良事件风险增加3.5倍 (OR,3.20) 和10年生存率降低 (HR,1.76) 相关.
- 在初级和再手术ARR组 (0.9%与0.3%) 之间以及在再手术ARR子组 (0%与1.2%) 之间,手术死亡率相似.
结论:
- 接受重复手术的ARR患者出现了更多的并发症和晚期大动脉疾病.
- 重新操作显著增加重大不良事件的风险,并减少ARR后的长期存活率.
- 尽管风险增加,但复手性ARR的手术死亡率与初级ARR相当.
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