Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, Hirosaki, Japan.
Ann Thorac Surg. 2010 Jul;90(1):72-7. doi: 10.1016/j.athoracsur.2010.03.047.
The aim of this study was to analyze mortality and morbidity of patients undergoing total arch replacement.
We analyzed data from 122 patients who underwent total arch replacement. Total arch replacement was performed using selective cerebral perfusion, with an open distal anastomosis using a trifurcated coated graft. Univariate and multivariate analysis were performed concerning postoperative neurologic dysfunction and early mortality. Long-term mortality was estimated by the Kaplan-Meier method.
Permanent and temporary neurologic dysfunction were 4.1% (5 cases) and 5.7% (7 cases), respectively. Hospital mortality was 8.2% (10 cases). There was no significant difference in hospital mortality or neurologic dysfunction between the two groups divided by age less than or greater than 70 years old, emergency versus elective surgery, and dissection versus true aneurysm. After multivariate analysis, independent predictors for hospital mortality were found to be infection, operation time longer than 10 hours, and EuroSCORE greater than 15; whereas those for neurologic dysfunction were operation time longer than 10 hours and ischemic heart disease. Overall long-term survival was 80.4% at 5 years and 58.9% at 10 years.
The early and long-term outcomes of total arch replacement using selective cerebral perfusion and appropriate establishment of cardiopulmonary bypass were satisfactory.
本研究旨在分析全主动脉弓置换术患者的死亡率和发病率。
我们分析了 122 例行全主动脉弓置换术患者的数据。全主动脉弓置换术采用选择性脑灌注，使用分叉涂层移植物进行开放远端吻合。对术后神经功能障碍和早期死亡率进行单因素和多因素分析。通过 Kaplan-Meier 法估计长期死亡率。
永久性和暂时性神经功能障碍分别为 4.1%（5 例）和 5.7%（7 例）。住院死亡率为 8.2%（10 例）。按年龄小于或大于 70 岁、急诊与择期手术、夹层与真性动脉瘤分组，住院死亡率或神经功能障碍无显著差异。多因素分析显示，住院死亡率的独立预测因素为感染、手术时间超过 10 小时和 EuroSCORE 大于 15；而神经功能障碍的独立预测因素为手术时间超过 10 小时和缺血性心脏病。总体 5 年生存率为 80.4%，10 年生存率为 58.9%。
采用选择性脑灌注和适当建立体外循环的全主动脉弓置换术的早期和长期结果令人满意。
