Mesana T G, Caus T, Gaubert J, Collart F, Ayari R, Bartoli J, Moulin G, Monties J
Department of Adult Cardiac Surgery, Timone Hospital, Boulevard Jean Moulin, 13385, Marseille, France.
Eur J Cardiothorac Surg. 2000 Sep;18(3):313-20. doi: 10.1016/s1010-7940(00)00512-1.
Advances in surgical technique have improved early survival after surgery of the ascending aorta. However, follow-up data document serious late complications, mainly evolutive peri-prosthetic false aneurysms. Magnetic resonance imaging (MRI) has proved to be highly effective for monitoring these complications. This study evaluates 10 years of experience with routine MRI for follow-up.
Since January 1988, 114 patients with replacement of the ascending aorta either for type A acute dissection (group I, 45 patients) or aneurysms (group II, 69 patients) were followed up with annual MRI. Prosthetic replacement was either limited to supra-coronary ascending aorta (45%, 51/114) or extended to the aortic root and/or the aortic arch (55%). Biological glue was always utilized. MRI focused on peri-prosthetic haematoma, analyzing signal intensity changes and volume augmentation for early detection of false aneurysms, and on persistent residual dissection with or without evolutive aortic aneurysm distant to the prosthesis.
Peri-prosthetic hematomas were almost equally found in both groups (26 (58%) in group I and 42 (61%) in group II) and were detected within the first year. Peri-prosthetic false aneurysms developed in 15 patients (group I, seven; group II, eight) as a complication of pre-existing hematomas and were indicated for elective reoperation. Forty-three (96%) of patients in group I had persistent residual dissection. Five patients in group I and two in group II needed reoperation for evolutive aortic aneurysm. In total, 22 of 114 (19%) patients were reoperated on during follow-up (12 (27%) in group I and ten (15%) in group II). Operative mortality was 13% (3/22). Freedom from reoperation at 1 year/5 years was: group I, 93%/84%; group II, 98%/88%.
Peri-prosthetic haematoma occurs equally after aneurysm or dissection repairs and is a pre-existing condition for peri-prosthetic false aneurysm; biological glue or extended repair do not prevent late complications. Long-term MRI follow-up allows successful elective reoperation for life-threatened but asymptomatic patients.
手术技术的进步提高了升主动脉手术后的早期生存率。然而，随访数据显示存在严重的晚期并发症，主要是进展性人工血管周围假性动脉瘤。磁共振成像（MRI）已被证明在监测这些并发症方面非常有效。本研究评估了10年来常规MRI随访的经验。
自1988年1月起，对114例行升主动脉置换术的患者进行了年度MRI随访，这些患者中，45例为A型急性主动脉夹层（I组），69例为动脉瘤（II组）。人工血管置换仅限于冠状动脉上方的升主动脉（45%，51/114）或扩展至主动脉根部和/或主动脉弓（55%）。均使用了生物胶。MRI重点观察人工血管周围血肿，分析信号强度变化和体积增大情况以早期发现假性动脉瘤，并观察有无持续性残余夹层以及距人工血管远处有无进展性主动脉瘤。
两组中人工血管周围血肿的发生率相近（I组26例（58%），II组42例（61%）），且均在第1年内被发现。15例患者（I组7例，II组8例）发生了人工血管周围假性动脉瘤，这是先前存在的血肿的并发症，均接受了择期再次手术。I组43例（96%）患者存在持续性残余夹层。I组5例患者和II组2例患者因进展性主动脉瘤需要再次手术。在随访期间，114例患者中有22例（19%）接受了再次手术（I组12例（27%），II组10例（15%））。手术死亡率为13%（3/22）。1年/5年的无再次手术生存率为：I组，93%/84%；II组，98%/88%。
动脉瘤或夹层修复术后人工血管周围血肿的发生率相同，且是人工血管周围假性动脉瘤的前期情况；生物胶或扩大修复并不能预防晚期并发症。长期MRI随访可为有生命危险但无症状的患者成功进行择期再次手术。
