Jault Frédérique, Rama Akhtar, Lievre Laurence, Bonnet Nicolas, Leprince Pascal, Pavie Alain, Gandjbakhch Iradj
Department of Cardiovascular and Thoracic Surgery, Hôpital de la Pitié Salpetrière, service du Pr Gandjbakhch, 83 boulevard de l'Hôpital, 75013 Paris, France.
Eur J Cardiothorac Surg. 2006 Jun;29(6):1041-5. doi: 10.1016/j.ejcts.2006.02.034. Epub 2006 May 3.
We study here the surgical results of chronic dissection involving the ascending aorta over the last 20 years. Patients with previous cardiac surgery, or proximal aortic repair, were excluded. The patients survived an acute dissection, undiagnosed as pauci- or asymptomatic. The aorta was normal or pathological (atheromatous aneurysm in 15 cases, Marfan's disease in 12 cases, and annuloectasic disease in 18 cases). Two patients had a bicuspid aortic valve.
Between January 1981 and December 2001, 77 patients (mean age 48+/-15) underwent surgery for chronic dissection of the ascending aorta; 60 patients had severe aortic regurgitation, 12 had Marfan syndrome, and 18 had annuloaortic ectasia. Only the ascending aorta was dissected in 37 patients, the ascending aorta and arch in 26, and the whole aorta in 14. Coronary artery disease occurred in five patients. Statistical analysis was performed using SAS software. Different surgical procedures were used. The aortic arch was repaired in 40 cases; selective antegrade cerebral perfusion and partial circulatory arrest were used. Total aortic replacement was performed on four patients.
In-hospital mortality was 10%. The only risk factor was the extent of the dissection. The rate of neurologic stroke was 2.5%. Late survival rate was 42+/-7.5% at 12 years for all the patients; it was 71+/-10% when only the ascending aorta was dissected, 44+/-11% when the ascending aorta and arch were dissected, and 33+/-15% when the whole aorta was dissected (p = 0.0329). The extent of the dissection was the only risk factor for late mortality. Reoperation was required for one proximal and five distal problems.
In chronic aortic dissection, in-hospital and late mortality were related to the extent of the dissection; in-hospital mortality remained unchanged during the operative period.
我们在此研究过去20年中累及升主动脉的慢性主动脉夹层的手术结果。排除既往有心脏手术或近端主动脉修复史的患者。患者经历过急性主动脉夹层且未被诊断为轻症或无症状。主动脉正常或存在病变（15例为动脉粥样硬化性动脉瘤，12例为马凡综合征，18例为主动脉瓣环扩张病）。2例患者有二叶式主动脉瓣。
1981年1月至2001年12月期间，77例（平均年龄48±15岁）患者接受了升主动脉慢性夹层的手术；60例患者有严重主动脉瓣反流，12例有马凡综合征，18例有主动脉瓣环扩张。仅升主动脉夹层的患者有37例，升主动脉和主动脉弓夹层的有26例，整个主动脉夹层的有14例。5例患者有冠状动脉疾病。使用SAS软件进行统计分析。采用了不同的手术方法。40例患者修复了主动脉弓；采用了选择性顺行脑灌注和部分循环阻断。4例患者进行了全主动脉置换。
住院死亡率为10%。唯一的危险因素是夹层范围。神经系统卒中发生率为2.5%。所有患者12年的晚期生存率为42±7.5%；仅升主动脉夹层时为71±10%，升主动脉和主动脉弓夹层时为44±11%，整个主动脉夹层时为33±15%（p = 0.0329）。夹层范围是晚期死亡的唯一危险因素。1例近端和5例远端问题需要再次手术。
在慢性主动脉夹层中，住院死亡率和晚期死亡率与夹层范围有关；手术期间住院死亡率保持不变。
