总主动脉弧替换与近道主动脉修复急性型的主动脉剖析:一个单一中心30年的经验
Delano J de Oliveira Marreiros1, Bardia Arabkhani1, Jos L Verhoef1
1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
JTCVS open
|March 10, 2025
概括
对急性A型大动脉解剖进行最佳的手术管理需要评估患者的风险. 虽然全门置换显示了有利的长期存活率,但结果取决于早期的术后存活率和临床表现.
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:
- 急性甲型大动脉解剖 (aTAAD) 的手术管理是复杂的,关于最佳的大动脉门修复策略的持续辩论.
- 技术范围从近端大动脉修复到更广泛的全门置换 (TAR).
研究的目的:
- 为了比较全门置换 (TAR) 和近道主动脉修复之间的临床结果,用于急性A型主动脉剖析患者.
- 评估外科手术对死亡率,再干预,中风和输血阻断的影响.
主要方法:
- 在1992年至2021年期间接受治疗的357名aTAAD患者的回顾性分析.
- 对TAR (76名患者) 和近端修复 (281名患者) 的结局进行比较.
- 终点包括全因死亡率,远端大动脉再干预,中风和perfusion综合征.
主要成果:
- 随着时间的推移,TAR的住院死亡率下降,与2010年后的近似修复相当.
- 对TAR的10年生存率为64.3%,对近位修复的54.3%.
- 两组之间没有观察到远程再干预,中风或放血的显著差异.
结论:
- 对aTAAD的住院死亡率已经下降,TAR的使用越来越多.
- 治疗后的长期存活是有利的,但取决于早期的术后结果.
- 手术策略应该是个性化的,考虑对大动脉重置手术的风险患者的TAR.
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