Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):841-7.e1; discussion 847. doi: 10.1016/j.jtcvs.2009.12.007. Epub 2010 Feb 1.
Prognostic implications of partial thrombosis of the residual aorta after repair of acute DeBakey type I aortic dissection have not been elucidated. We sought to analyze the impact of partial thrombosis on segmental growth rates, distal aortic reprocedures, and long-term survival.
A total of 118 consecutive patients (55% were male; mean age, 60 years) with acute DeBakey type I aortic dissection underwent surgical repair (1997-2007). The hospital mortality rate was 17.8%. Survivors underwent serial computed tomography scans. Segment-specific average rates of enlargement were analyzed. Distal reprocedures and patient survival were examined.
Sixty-six patients had imaging data sufficient for growth rate calculations. The median diameters within 2 weeks after repair were as follows: aortic arch, 3.5 cm; descending aorta, 3.6 cm; and abdominal aorta, 2.4 cm. Subsequent growth rates were artic arch, 0.34 mm/y, descending aorta, 0.51 mm/y, and abdominal aorta, 0.35 mm/y. Partial thrombosis of the residual aorta predicted greater growth in the distal aorta (P = .005). There were 13 distal aortic reprocedures (5 reoperations, 8 stent graft insertions) for 10 years, and reprocedure-free survival was 66%. Partial thrombosis (P = .002) predicted greater risk of aorta-related reprocedures. Cox analysis revealed that estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) (P = .030), reintubation (P = .002), and partial thrombosis (P = .023) were independent predictors for poor survival.
Partial thrombosis of the false lumen after repair of acute DeBakey type I aortic dissection, compared with complete patency or complete thrombosis, is a significant independent predictor of aortic enlargement, aorta-related reprocedures, and poor long-term survival.
急性 Debakey Ⅰ型主动脉夹层修复术后残余主动脉部分血栓形成的预后意义尚未阐明。我们旨在分析部分血栓形成对节段性生长速度、远端主动脉再处理和长期生存的影响。
118 例连续急性 Debakey Ⅰ型主动脉夹层患者（55%为男性；平均年龄 60 岁）接受了手术修复（1997-2007 年）。医院死亡率为 17.8%。幸存者接受了连续的计算机断层扫描。分析了特定节段的平均扩大率。检查了远端再处理和患者生存情况。
66 例有足够的影像学数据进行生长率计算。修复后 2 周内的中位数直径如下：主动脉弓 3.5cm；降主动脉 3.6cm；腹主动脉 2.4cm。随后的生长速度分别为主动脉弓 0.34mm/y、降主动脉 0.51mm/y 和腹主动脉 0.35mm/y。残余主动脉的部分血栓形成预测远端主动脉的生长更大（P =.005）。10 年内有 13 例远端主动脉再处理（5 例再次手术，8 例支架置入），无再处理存活率为 66%。部分血栓形成（P =.002）预测更高的主动脉相关再处理风险。Cox 分析显示，估计肾小球滤过率低于 60ml/min/1.73m²（P =.030）、重新插管（P =.002）和部分血栓形成（P =.023）是不良生存的独立预测因素。
与完全通畅或完全血栓形成相比，急性 Debakey Ⅰ型主动脉夹层修复术后假腔的部分血栓形成是主动脉扩大、主动脉相关再处理和不良长期生存的显著独立预测因素。
