Yeh Chi-Hsiao, Chen Min-Chi, Wu Yi-Cheng, Wang Yao-Chang, Chu Jaw-Ji, Lin Pyng Jing
Division of Thoracic & Cardiovascular Surgery, Chang Gung Memorial Hospital, 5 Fu-Hsing Street, Kweishan, Taoyuan, Taipei, Taiwan 333, ROC.
Chest. 2003 Sep;124(3):989-95. doi: 10.1378/chest.124.3.989.
After surgery to repair a type A aortic dissection, most late complications and mortality result from descending aorta-related problems. This study was performed to determine the risk factors leading to descending aortic aneurysm formation and late mortality in patients undergoing the type A aortic dissection operation.
The medical records of patients who survived the operation for type A aortic dissection between 1984 and 1998 were reviewed. There were 144 patients (95 men and 49 women), ranging in age from 24 to 78 years (mean age, 52 years). Most patients were acutely ill, 15 patients were in shock, and 54 patients had cardiac tamponade at the time of the surgical procedure. One hundred thirty-seven patients had ascending aortic replacement only, and of the other 6 patients 2 had hemiarch and 4 had total arch replacement using the elephant trunk technique. The aortic valve was replaced in 23 patients, resuspended in 100, and untouched in 21. Twenty-four risk factors were evaluated in statistical analyses for the prediction of descending aortic aneurysm formation and 3-year mortality. Risk factors were investigated using univariate and multiple logistic regression and survival analyses.
The 3-year, 5-year, and 8-year cumulative survival rates were 96.2%, 89.1%, and 80.0%, respectively. The 3-year, 5-year, and 8-year cumulative survival rates, free from descending aortic aneurysm formation or descending aorta operation, were 74.7%, 58.6%, and 43.0%, respectively. Multivariate analysis confirmed that patent false lumen and initial descending aortic diameter were statistically significant risk factors for descending aortic aneurysm formation.
The medium-term survival rate of patients who received operations for type A aortic dissection was satisfactory, despite the high incidence of descending aortic aneurysm formation. The intimal entry site over the aortic arch that was resected during the first operation could decrease the patency rate of a false lumen over the descending aorta. In the absence of a patent false lumen over the descending aorta, the chance of descending aortic aneurysm formation or operation is lessened, and the late survival rate is increased.
在A型主动脉夹层修复手术后，大多数晚期并发症和死亡是由降主动脉相关问题导致的。本研究旨在确定A型主动脉夹层手术患者降主动脉瘤形成和晚期死亡的危险因素。
回顾了1984年至1998年间A型主动脉夹层手术存活患者的病历。共有144例患者（95例男性和49例女性），年龄在24至78岁之间（平均年龄52岁）。大多数患者病情危急，15例患者处于休克状态，54例患者在手术时有心包填塞。137例患者仅进行了升主动脉置换，另外6例患者中，2例进行了半弓置换，4例采用象鼻技术进行了全弓置换。23例患者置换了主动脉瓣，100例患者进行了主动脉瓣悬吊，21例患者未触及主动脉瓣。在统计分析中评估了24个危险因素，以预测降主动脉瘤形成和3年死亡率。使用单因素和多因素逻辑回归及生存分析对危险因素进行了研究。
3年、5年和8年的累积生存率分别为96.2%、89.1%和80.0%。无降主动脉瘤形成或降主动脉手术的3年、5年和8年累积生存率分别为74.7%、58.6%和43.0%。多因素分析证实，假腔通畅和初始降主动脉直径是降主动脉瘤形成的统计学显著危险因素。
尽管降主动脉瘤形成的发生率较高，但接受A型主动脉夹层手术患者的中期生存率令人满意。首次手术期间切除的主动脉弓内膜入口部位可能会降低降主动脉假腔的通畅率。在降主动脉不存在通畅假腔的情况下，降主动脉瘤形成或手术的机会减少，晚期生存率提高。
