Kallenbach Klaus, Oelze Timm, Salcher Rolf, Hagl Christian, Karck Matthias, Leyh Rainer G, Haverich Axel
Hannover Medical School, Department of Thoracic and Cardiovascular Surgery, Hannover, Germany.
Circulation. 2004 Sep 14;110(11 Suppl 1):II243-9. doi: 10.1161/01.CIR.0000138948.14144.d6.
To assess the outcome of 3 different surgical approaches for treatment of acute aortic dissection type A (AADA).
Between October 1990 and October 2003, we operated on 295 patients (pts) for AADA. Follow-up was complete for 257 pts (87%). Supracommissural replacement (SCR) of the ascending aorta was applied to 145 pts, 64 pts received a composite replacement (comp), and 48 pts were treated with the aorta valve-sparing (AVS) reimplantation technique. Pts in SCR were older compared with AVS and comp (P=0.002), gender (overall 65% male, P=0.143) and presence of Marfan syndrome (overall 5%, P=0.109) were comparable. Cannulation of the aorta was performed more often in AVS (58%) than in comp (19%) or SCR (22%; P<0.001). Mean operation time, extracorporeal circulation time, and aortic cross-clamp time differ significantly between groups (P<0.001, respectively). Stay in the intensive care unit (P=0.12) and time of hospitalization (P=0.32) were comparable. Overall perioperative mortality was 24% and did not show significant differences between groups (AVS 10.4% versus comp 28% versus SCR 26%; P=0.053). Incidence of neurological complications was similar between groups (P=0.95). Mean time of follow-up was shorter for AVS (19+/-20 months) compared with comp (48+/-48 months) and SCR (46+/-45 months). Survival at 5 years was comparable with 89% for AVS, 85% for comp, and 80% for SCR (P=0.61). Two patients from AVS (4.1%) required reoperation for failure of the reconstructed valve. Pts in comp required less aortic reoperations than pts in SCR (comp 6.3% versus SCR 22%; P=0.005).
In acute aortic dissection type A, the reimplantation technique leads to results comparable to established techniques. Complete removal of diseased tissue, low incidence of reoperation, and lack of anticoagulation may favor this approach in selected patients.
评估三种不同手术方法治疗急性A型主动脉夹层（AADA）的疗效。
1990年10月至2003年10月，我们对295例急性A型主动脉夹层患者进行了手术。257例（87%）患者获得完整随访。145例患者采用升主动脉超瓣环置换术（SCR），64例患者接受复合置换术（comp），48例患者采用保留主动脉瓣（AVS）再植入技术治疗。SCR组患者年龄大于AVS组和comp组（P=0.002），性别（总体男性占65%，P=0.143）和马凡综合征的发生率（总体5%，P=0.109）在各组间相当。AVS组主动脉插管的频率（58%）高于comp组（19%）或SCR组（22%；P<0.001）。各组间平均手术时间、体外循环时间和主动脉阻断时间差异有统计学意义（P均<0.001）。重症监护病房停留时间（P=0.12）和住院时间（P=0.32）各组间相当。围手术期总体死亡率为24%，各组间无显著差异（AVS组10.4%，comp组28%，SCR组26%；P=0.053）。各组神经并发症发生率相似（P=0.95）。AVS组平均随访时间（19±20个月）短于comp组（48±48个月）和SCR组（46±45个月）。AVS组5年生存率为89%，comp组为85%，SCR组为80%，三组相当（P=0.61）。AVS组有2例患者（4.1%）因重建瓣膜功能衰竭需要再次手术。comp组患者主动脉再次手术的需求少于SCR组（comp组6.3%，SCR组22%；P=0.005）。
在急性A型主动脉夹层中，再植入技术的疗效与成熟技术相当。彻底清除病变组织、再次手术发生率低以及无需抗凝可能使该方法在特定患者中具有优势。
