Mosquera Victor X, Herrera José M, Marini Milagros, Estevez Francisco, Cao Ignacio, Gulías Daniel, Valle José V, Cuenca José J
Department of Cardiothoracic Surgery, Juan Canalejo Hospital, La Coruña, Spain.
Interact Cardiovasc Thorac Surg. 2009 Jul;9(1):61-5. doi: 10.1510/icvts.2008.196402. Epub 2009 Apr 9.
Between May 2001 and June 2008, the outcome and morphological changes in thoracic aortic lesions of 20 surgical high-risk patients who underwent TEVAR were evaluated. Aortic lesions included 8 (40%) type B dissections, 5 (25%) atherosclerotic aneurysms, 4 (20%) penetrating ulcers and 3 (15%) traumatic aortic ruptures. All patients were classified as American Society of Anaesthesiologists class IV and obtained high scores in both the logistic European System for Cardiac Operative Risk Evaluation, median of 14.5% (range 8.1-65.7%), and the STS Parsonet 95 scoring system, median of 14 (range 10-52). Endovascular stent-graft deployment was technically successful in all cases. No surgical conversion occurred. Early mortality was observed in two patients. Clinical and imaging follow-up was available in all patients at a median time of 28 months (range 4-89 months). Overall actuarial survival was 90% at one and five years and 60% at seven years. Mean diameter of the descending aorta decreased from 51.1+/-13 mm to 45.3+/-8 mm (P=0.032). Mean reduction in dimension of aneurysms was 10.7+/-8 mm. Endovascular thoracic aorta repair will probably benefit more patients with multiple comorbidities that limit their life expectancy than patients with a lower profile.
在2001年5月至2008年6月期间，对20例接受胸主动脉腔内修复术（TEVAR）的外科手术高危患者的胸主动脉病变的结局和形态学变化进行了评估。主动脉病变包括8例（40%）B型主动脉夹层、5例（25%）动脉粥样硬化性动脉瘤、4例（20%）穿透性溃疡和3例（15%）创伤性主动脉破裂。所有患者均被分类为美国麻醉医师协会IV级，并且在欧洲心脏手术风险评估逻辑系统（中位数为14.5%，范围为8.1%-65.7%）和胸外科医师协会（STS）Parsonet 95评分系统（中位数为14，范围为10-52）中均获得高分。血管内支架移植物植入在所有病例中技术上均获成功。未发生转为外科手术的情况。观察到2例患者早期死亡。所有患者均进行了临床和影像学随访，中位时间为28个月（范围为4-89个月）。1年和5年的总体精算生存率为90%，7年时为60%。降主动脉的平均直径从51.1±13 mm降至45.3±8 mm（P=0.032）。动脉瘤尺寸的平均缩小为10.7±8 mm。与病情较轻的患者相比，血管内胸主动脉修复术可能会使更多合并多种疾病且预期寿命受限的患者受益。
