Dossche K M, Tan M E, Schepens M A, Morshuis W J, de la Rivière A B
Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Eur J Cardiothorac Surg. 1999 Dec;16(6):607-12. doi: 10.1016/s1010-7940(99)00326-7.
A retrospective analysis of early and late outcome for late (>4 weeks) reoperations on the ascending aorta or aortic root.
During a 24-year interval, starting in 1974, 834 patients underwent replacement of the ascending aorta (39.2%) or aortic root (60.8%). During the same period, 56 patients with a mean age of 51.1 +/- 14.4 years underwent reoperation after ascending aortic or aortic root replacement. Predominant indications for reoperation were false aneurysm in 25 (44.6%) patients and true aneurysm in 18 (32.1%) patients. Most frequent surgical procedures were redo aortic root replacement in 30 (53.6%) patients and closure of a false aneurysm in 14 (25.0%) patients. Median interval between the operations was 51 months. Eighteen (32.2%) patients underwent concomitant partial or total aortic arch replacement.
Hospital mortality was 5.4% (n = 3; 70% CL: 2.4-8.4%). Cause of death was low cardiac output in two patients and rupture of the aorta at the distal suture line in one patient. Univariate analysis identified two or more previous operations (P = 0.038) and the interval between initial operation and reoperation for complication of less than 8 months (P = 0.005) as risk factors for hospital death. Multivariate analysis indicated operation for active endocarditis or vascular graft infection as an independent risk factor for hospital death (P = 0.038, odds 14.6). Follow-up was complete, median 3.1 years. Nine (16.9%; 70% CL: 11.7-22.1%) patients died during that period. Estimated survival at 1, 5 and 10 years was 91.2, 84.0 and 76.4%. One patient underwent another reoperation. Estimated event-free survival at 1, 5 and 10 year is 84.3, 72.2 and 65.6%.
False aneurysm formation and progression of aneurysmatic disease are the predominant causes for late reoperations after aortic root or ascending aortic replacement. Reoperations can be performed with low hospital mortality and good late results.
对升主动脉或主动脉根部晚期（>4周）再次手术的早期和晚期结果进行回顾性分析。
从1974年开始的24年间，834例患者接受了升主动脉置换术（39.2%）或主动脉根部置换术（60.8%）。同期，56例平均年龄为51.1±14.4岁的患者在升主动脉或主动脉根部置换术后接受了再次手术。再次手术的主要指征为25例（44.6%）患者的假性动脉瘤和18例（32.1%）患者的真性动脉瘤。最常见的手术方式为30例（53.6%）患者进行再次主动脉根部置换术，14例（25.0%）患者闭合假性动脉瘤。两次手术之间的中位间隔时间为51个月。18例（32.2%）患者同时进行了部分或全主动脉弓置换术。
医院死亡率为5.4%（n = 3；70%可信区间：2.4 - 8.4%）。死亡原因是2例患者心输出量低，1例患者主动脉远端缝合线处破裂。单因素分析确定既往进行过两次或更多次手术（P = 0.038）以及初次手术与因并发症进行再次手术之间的间隔时间少于8个月（P = 0.005）为医院死亡的危险因素。多因素分析表明，因活动性心内膜炎或血管移植物感染进行手术是医院死亡的独立危险因素（P = 0.038，比值为14.6）。随访完整，中位时间为3.1年。在此期间有9例（16.9%；70%可信区间：11.7 - 22.1%）患者死亡。1年、5年和10年的预计生存率分别为91.2%、84.0%和76.4%。1例患者接受了另一次再次手术。1年、5年和10年的预计无事件生存率分别为84.3%、72.2%和65.6%。
假性动脉瘤形成和动脉瘤性疾病进展是主动脉根部或升主动脉置换术后晚期再次手术的主要原因。再次手术可在低医院死亡率和良好的晚期结果下进行。
