Department of Cardiac Surgery, IRCCS Istituto Clinico Humanitas, Rozzano, Italy.
Ann Thorac Surg. 2010 Nov;90(5):1437-43. doi: 10.1016/j.athoracsur.2010.06.103.
Aortic false aneurysm is a rare complication after cardiac surgery. Aortic dissection, infection, arterial wall degeneration, and poor surgical technique are recognized as risk factors for the occurrence of postsurgical false aneurysm. Despite some recent reports about percutaneous false aneurysm exclusion, a complex surgical reoperation is needed in most of the cases.
We retrospectively reviewed our experience in 43 patients who received a reoperation for postsurgical aortic false aneurysm in the last 14 years. Thirty-three patients were male. The mean age was 60 ± 12 years. Most of the patients received prior aortic surgery on the aortic root, the ascending aorta, the aortic arch, and the descending thoracic aorta (38 patients). False aneurysm was diagnosed during follow-up evaluation in the absence of any symptoms in 23 cases. Univariate and multivariate analyses on 18 perioperative variables were performed.
In-hospital mortality was 6.9% (3 patients). The postoperative course was complicated in 17 cases (39%). At multivariate analysis, a preoperative history of coronary artery disease and postoperative sepsis were independent risk factors for hospital mortality. Survival rates at 1, 5, and 10 years were 94%, 79%, and 68%, respectively. Freedom from reoperation was 86% at 1 year and 72% at 5 and 10 years.
Despite a high postoperative complication rate, a reoperation for postsurgical aortic false aneurysm can be performed with acceptable mortality and good mid-term and long-term outcomes.
主动脉假性动脉瘤是心脏手术后罕见的并发症。主动脉夹层、感染、动脉壁退行性变和手术技术不佳被认为是术后假性动脉瘤发生的危险因素。尽管最近有一些关于经皮假性动脉瘤排除的报道，但大多数情况下仍需要进行复杂的再次手术。
我们回顾性分析了过去 14 年来 43 例因术后主动脉假性动脉瘤而接受再次手术的患者的经验。33 例为男性，平均年龄 60±12 岁。大多数患者先前在主动脉根部、升主动脉、主动脉弓和降胸主动脉接受过主动脉手术（38 例）。23 例在无任何症状的随访评估中诊断出假性动脉瘤。对 18 个围手术期变量进行单因素和多因素分析。
院内死亡率为 6.9%（3 例）。17 例（39%）术后病程复杂。多因素分析显示，术前冠心病病史和术后脓毒症是院内死亡的独立危险因素。1、5 和 10 年的生存率分别为 94%、79%和 68%。1 年时无再次手术的生存率为 86%，5 年和 10 年时为 72%。
尽管术后并发症发生率较高，但再次手术治疗术后主动脉假性动脉瘤可获得可接受的死亡率和良好的中期和长期结果。
